Study of serum uric acid levels in patients with acute coronary syndrome and its correlation with clinical features and Killip classification in patients attending tertiary care hospital in Kumaon region of Uttarakhand
DOI:
https://doi.org/10.18203/2320-6012.ijrms20261345Keywords:
Hyperuricemia, Serum uric acid, Prognostic marker, Killip classification, Acute coronary syndromeAbstract
Background: Acute coronary syndrome (ACS) is a major cause of morbidity and mortality worldwide. Serum uric acid has been suggested as a potential biomarker associated with oxidative stress and cardiovascular risk. This study aimed to evaluate the role of serum uric acid as a prognostic marker in patients with ACS and to assess its association with the Killip classification.
Methods: This prospective study was conducted in the Department of Medicine at Government Medical College and Dr. Susheela Tiwari Hospital, Haldwani, from January 2020 to September 2021. A total of 100 patients with confirmed ACS were included based on clinical presentation, ECG changes and elevated cardiac biomarkers. Serum uric acid levels were measured on day 1 and day 3 of admission. Patients were classified according to the Killip classification and clinical outcomes including mortality, complications and duration of hospital stay were recorded.
Results: Among the 100 patients, the mean age was 60.97±10.8 years and 63% were males. Hyperuricemia (>8 mg/dl) was observed in 30% of patients on day 1 and 24.49% on day 3. Higher uric acid levels were significantly associated with increased mortality, higher Killip class and greater disease severity (p<0.0001). Patients with hyperuricemia also showed higher prevalence of dyspnoea, hypertension, positive troponin levels, STEMI presentation and cardiovascular complications. Additionally, the duration of hospital stay was significantly longer among patients with elevated uric acid levels.
Conclusions: Elevated serum uric acid levels are significantly associated with increased severity, complications and mortality in patients with ACS. Serum uric acid may serve as a simple and useful prognostic biomarker for risk stratification in ACS patients.
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References
Zègre-Hemsey JK, Asafu-Adjei J, Fernandez A, Brice J. Characteristics of prehospital electrocardiogram use in North Carolina using a novel linkage of emergency medical services and emergency department data. Prehosp Emerg Care. 2019. DOI: https://doi.org/10.1080/10903127.2019.1597230
Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics—2019 update: a report from the American heart association. Circulation. 2019;139(10):28-58. DOI: https://doi.org/10.1161/CIR.0000000000000659
Centers for Disease Control and Prevention. Coronary artery disease. Available at: https://www.cdc.gov/heartdisease/facts.htm. Accessed on 21 August 2025.
Jan B, Dar MI, Choudhary B, Basist P, Khan R, Alhalmi A. Cardiovascular diseases among Indian older adults: A comprehensive review. Cardiovascular Therapeutics. 2024;2(1):6894693. DOI: https://doi.org/10.1155/2024/6894693
Miranda JJ, Barrientos-Gutiérrez T, Corvalan C. Understanding the rise of cardiometabolic diseases in low- and middle-income countries. Nat Med. 2019;25:1667–79. DOI: https://doi.org/10.1038/s41591-019-0644-7
Florek K, Kübler M, Gorka M, Kübler P. New modifiable risk factors influencing coronary artery disease severity. Int J Mol Sci. 2024;25(14):7766. DOI: https://doi.org/10.3390/ijms25147766
Di Lenarda F, Balestrucci A, Terzi R, Lopes P, Ciliberti G, Marchetti D, et al. coronary artery disease, family history and screening perspectives: an up-to-date review. J Clin Med. 2024;13(19):5833. DOI: https://doi.org/10.3390/jcm13195833
Juan-Salvadores P, Jiménez Díaz VA, Iglesia Carreño C, Guitián González A, Veiga C, Martínez Reglero C, et al. Coronary artery disease in very young patients: analysis of risk factors and long-term follow-up. J Cardiovas Dev Dis. 2022;9(3):82. DOI: https://doi.org/10.3390/jcdd9030082
Kong G, Chin YH, Chong B, Goh RS, Lim OZ, Ng CH, et al. Higher mortality in acute coronary syndrome patients without standard modifiable risk factors: results from a global meta-analysis of 1,285,722 patients. Int J Cardiol. 2023;371:432-40. DOI: https://doi.org/10.1016/j.ijcard.2022.09.062
Sigamani A, Gupta R. Revisiting secondary prevention in coronary heart disease. Indian Heart J. 2022;74(6):431-40. DOI: https://doi.org/10.1016/j.ihj.2022.11.011
Chung ST, Krenek A, Magge SN. Childhood obesity and cardiovascular disease risk. Curr Atherosclerosis Rep. 2023;25(7):405-15. DOI: https://doi.org/10.1007/s11883-023-01111-4
Jamee Shahwan A, Abed Y, Desormais I, Magne J, Preux PM, Aboyans V, et al. Epidemiology of coronary artery disease and stroke and associated risk factors in Gaza community—Palestine. PLoS One. 2019;14(1):211131. DOI: https://doi.org/10.1371/journal.pone.0211131
Ibrahim HK. Global trends in cardiovascular mortality and risk factors: insights from WHO and Global Burden of Disease data. Libyan Open University J Med Sci Sustainab. 2025;2:28-36. DOI: https://doi.org/10.65422/loujmss.v1i1.40
Hashmi KA, Adnan F, Ahmed O, Yaqeen SR, Ali J, Irfan M, et al. Risk assessment of patients after ST-segment elevation myocardial infarction by Killip classification: an institutional experience. Cureus. 2020;12:12209. DOI: https://doi.org/10.7759/cureus.12209
Katsioupa M, Kourampi I, Oikonomou E, Tsigkou V, Theofilis P, Charalambous G, et al. Novel biomarkers and their role in the diagnosis and prognosis of acute coronary syndrome. Life. 2023;13(10):1992. DOI: https://doi.org/10.3390/life13101992
Netala VR, Hou T, Wang Y, Zhang Z, Teertam SK. Cardiovascular biomarkers: tools for precision diagnosis and prognosis. Int J Mol Sci. 2025;26(7):3218. DOI: https://doi.org/10.3390/ijms26073218
Khameneh Bagheri R, Najafi MN, Ahmadi M, Saberi M, Maleki M, Baradaran Rahimi V. Investigation of the association between serum uric acid levels and HEART risk score in patients with acute coronary syndrome. Physiol Reports. 2022;10(22):15513. DOI: https://doi.org/10.14814/phy2.15513
Nabhan EB, Al-Hashimi H, Roqia SA, Baaj B, Nabhan E. A retrospective analysis of characteristics and outcomes of young ST-elevation myocardial infarction patients in the Dubai Population. Cureus. 2025;17(6):798. DOI: https://doi.org/10.7759/cureus.85565
Nedkoff L, Briffa T, Murray K, Gaw J, Yates A, Sanfilippo FM, et al. Risk of early recurrence and mortality in high-risk myocardial infarction patients: A population-based linked data study. Int J Cardiol Cardiovas Risk Prev. 2023;17:200185. DOI: https://doi.org/10.1016/j.ijcrp.2023.200185
Dafaalla M, Rashid M, Van Spall HG, Mehta L, Parwani P, Sharma G, et al. Women are less likely to survive AMI presenting with out-of-hospital cardiac arrest: A nationwide study. InMayo Clinic. 2022;97(9):1608-18. DOI: https://doi.org/10.1016/j.mayocp.2022.06.011
Khullar N, Buckley AJ, O’Connor C, Ibrahim A, Ibrahim A, Ahern C, et al. Peak troponin T in STEMI: a predictor of all-cause mortality and left ventricular function. Open Heart. 2022;23;9(1):64. DOI: https://doi.org/10.1136/openhrt-2021-001863
Zhang J, Liang Y, Song C, Hu Z. Association between serum uric acid to albumin ratio and all-cause mortality in critically ill patients with sepsis: a retrospective study. BMC Infect Dis. 2025;25(1):1718. DOI: https://doi.org/10.1186/s12879-025-12134-4
Kim JY, Seo C, Pak H, Lim H, Chang TI. Uric acid and risk of cardiovascular disease and mortality: A longitudinal cohort study. J Korean Med Sci. 2023;2:38. DOI: https://doi.org/10.3346/jkms.2023.38.e302
Bhatt DL, Lopes RD, Harrington RA. Diagnosis and treatment of acute coronary syndromes: a review. JAMA. 2022;327(7):662-75. DOI: https://doi.org/10.1001/jama.2022.0358
Kumar N, Kumar H, Kumar V, Nayyer PS. A study of the serum uric acid level as prognostic indicator in acute myocardial infarction. J Assoc Physicians India. 2020;68(2):31–4.
Nisar AB, Butt UM, Shah MR, Ayaz ME, Iqbal MK, Qureshi MA. In-hospital outcome among patients with acute coronary syndrome and smoking status admitted to a tertiary care hospital. Pakistan Heart J. 2026;59(1):134-8. DOI: https://doi.org/10.47144/phj.v59i1.3037
Ulvenstam A, Graipe A, Irewall AL, Söderström L, Mooe T. Incidence and predictors of cardiovascular outcomes after acute coronary syndrome in a population-based cohort study. Scientific Rep. 2023;13(1):3447. DOI: https://doi.org/10.1038/s41598-023-30597-w
Karki M, Rokaya N, Khatri P, Shahi A, Sah A. Study of Serum Uric Acid Level in Acute Coronary Syndrome in Nepalese Subjects. Trends J Sci Res. 2019;4(1):21-8. DOI: https://doi.org/10.31586/Cardiology.0401.04
Mihajlović D, Maksimović Ž, Dojčinović B, Banjac N. Acute coronary syndrome (STEMI, NSTEMI and unstable angina pectoris) and risk factors, similarities and differences. Scripta Medica. 2020;51(4):252–60. DOI: https://doi.org/10.5937/scriptamed51-27722
Freilich M, Arredondo A, Zonnoor SL, McFarlane IM, McFarlane I. Elevated serum uric acid and cardiovascular disease: a review and potential therapeutic interventions. Cureus. 2022;14(3):758. DOI: https://doi.org/10.7759/cureus.23582
Zhang S, Liu X, Song B, Yu H, Zhang X, Shao Y. Impact of serum uric acid levels on the clinical prognosis and severity of coronary artery disease in patients with acute coronary syndrome and hypertension after percutaneous coronary intervention: a prospective cohort study. BMJ Open. 2022;12(1):52031. DOI: https://doi.org/10.1136/bmjopen-2021-052031
Lazzeri C, Valente S, Chiostri M, Sori A, Bernardo P, Gensini GF. Uric acid in the acute phase of ST elevation myocardial infarction submitted to primary PCI: Its prognostic role and relation with inflammatory markers—a single-center experience. Int J Cardiol. 2010;138(2):206–9. DOI: https://doi.org/10.1016/j.ijcard.2008.06.024