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J Thorac Cardiovasc Surg 2009;138:200-205
© 2009 The American Association for Thoracic Surgery

Perioperative Management

Uric acid levels and outcome from coronary artery bypass grafting

^a Department of Cardiology, University of Aberdeen and Aberdeen Royal Infirmary, Aberdeen, United Kingdom
^b Health Services Research Unit, University of Aberdeen and Aberdeen Royal Infirmary, Aberdeen, United Kingdom
^c Department of Clinical Biochemistry, University of Aberdeen and Aberdeen Royal Infirmary, Aberdeen, United Kingdom
^d Department of Cardiac Surgery, University of Aberdeen and Aberdeen Royal Infirmary, Aberdeen, United Kingdom

Received for publication May 29, 2008; revisions received November 6, 2008; accepted for publication December 25, 2008.

^_* Address for reprints: Graham S. Hillis, MBChB, PhD, Cardiovascular Division, The George Institute for International Health, Royal Prince Alfred Hospital, Sydney NSW 2050, Australia. (Email: ghillis{at}george.org.au).

Objective: Elevated uric acid levels have been associated with an adverse cardiovascular outcome in several settings. Their utility in patients undergoing surgical revascularization has not, however, been assessed. We hypothesized that serum uric acid levels would predict the outcome of patients undergoing coronary artery bypass grafting.

Methods: The study cohort consisted of 1140 consecutive patients undergoing nonemergency coronary artery bypass grafting. Clinical details were obtained prospectively, and serum uric acid was measured a median of 1 day before surgery. The primary end point was all-cause mortality.

Results: During a median of 4.5 years, 126 patients (11%) died. Mean (± standard deviation) uric acid levels were 390 ± 131 µmol/L in patients who died versus 353 ± 86 µmol/L among survivors (hazard ratio 1.48 per 100 µmol/L; 95% confidence interval, 1.25–1.74; P < .001). The excess risk associated with an elevated uric acid was particularly evident among patients in the upper quartile (410 µmol/L; hazard ratio vs all other quartiles combined 2.18; 95% confidence interval, 1.53–3.11; P < .001). After adjusting for other potential prognostic variables, including the European System for Cardiac Operative Risk Evaluation, uric acid remained predictive of outcome.

Conclusion: Increasing levels of uric acid are associated with poorer survival after coronary artery bypass grafting. Their prognostic utility is independent of other recognized risk factors, including the European System for Cardiac Operative Risk Evaluation.

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Uric acid levels and outcomes from coronary artery bypass grafting: Is it the chicken or the egg?

Harold L. Lazar
J. Thorac. Cardiovasc. Surg. 2009 138: 8. [Extract] [Full Text] [PDF]

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				H. L. Lazar Uric acid levels and outcomes from coronary artery bypass grafting: Is it the chicken or the egg? J. Thorac. Cardiovasc. Surg., July 1, 2009; 138(1): 8 - 8. [Full Text] [PDF]