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

Background: 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. Methods: 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. Results: 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). Conclusions: In a cohort with acute myocardial infarction, hyperuricemia was independently associated with all-cause mortality in patients with HFpEF. Clinical Trial Registration: ClinicalTrials.gov, COREA-AMI NCT02806102.