# The role of serum uric acid in survival prediction in patients with acute myocardial infarction accompanied by heart failure with preserved ejection fraction

## TL;DR

High blood uric acid levels are linked to higher death rates in patients with heart failure and preserved ejection fraction following a heart attack.

## Contribution

This study identifies serum uric acid as an independent predictor of mortality in HFpEF patients with acute myocardial infarction.

## Key findings

- Hyperuricemia was independently associated with all-cause mortality (hazard ratio: 1.5).
- Higher uric acid levels correlated with increased cardiovascular death rates.
- The association remained significant in patients with higher HFA-PEFF scores.

## Abstract

Heart failure with preserved ejection fraction (HFpEF) is defined as presenting with clinical symptoms and signs of heart failure with a concomitant left ventricular ejection fraction ≥50%. However, the prognostic role of serum uric acid in HFpEF is not well understood.

In total, 757 patients with HFpEF and acute myocardial infarction were included in the analysis. Hyperuricemia was defined as a serum uric acid level >6.9 mg/dL in men and >5.4 mg/dL in women at the time of diagnosis of acute myocardial infarction. The primary outcome was all-cause mortality.

Among the enrolled patients, 164 and 593 were placed into the high uric acid and normal uric acid groups, respectively. After a median follow up of 4.8 years [interquartile range: 3.2–7.1], 54 (32.9%) in the high serum uric acid group and 92 (15.5%) in the normal serum uric acid group had died. Hyperuricemia was independently associated with all-cause mortality (p < 0.001) and cardiovascular death [73 (12.3%) vs. 44 (26.8%); p < 0.001]. The increased risk of mortality remained consistent in the multivariate Cox proportional hazards model (hazard ratio: 1.5; 95% confidence interval: 1.03–2.19; p = 0.033). After classifying the enrolled patients according to their Heart Failure Association-Pre-test assessment, Echocardiography and natriuretic peptide, Functional testing, and Final etiological work-up (HFA-PEFF) score (366 with a HFA-PEFF score <3 and 391 with a HFA-PEFF score ≥3), hyperuricemia was also found to be associated with all-cause mortality in patients with a score greater than the intermediate score (≥3 points) (p < 0.001).

In a cohort with acute myocardial infarction, hyperuricemia was independently associated with all-cause mortality in patients with HFpEF.

ClinicalTrials.gov, COREA-AMI NCT02806102.