Published: 2019-07-24

A comparative study of serum uric acid level in various acute coronary syndromes and its short term prognostic significance using KILLIP classification

Devendra Ajmera, Nirmal Kumar Sharma, Saurabh Chittora


Background: Serum uric acid is increased in ischemic conditions and is significantly higher in patients with acute myocardial infarction. The aim of study was to correlate serum uric acid level with KILLIP class in respect of mortality and morbidity profile of patients with acute coronary syndromes..

Methods: 100 patients fulfilling the standard diagnostic criteria for acute coronary syndromes on the basis of classical history, clinical signs, ECG changes and biomarkers were included in the study. Age and sex matched 50 normal healthy subjects were also included as control group after obtaining informed consent.  Serum uric acid level was measured on day 0, 3 and 7 of various ACS.

Results: There was statistically significant higher level of serum uric acid concentration in patients of AMI on day of admission as compared to controls and unstable angina patients. On all three days of serum uric acid estimation, the serum uric acid levels were higher in AMI patients who were in higher KILLIP class as compared to lower KILLIP class group. Smokers had significantly higher baseline serum uric acid but age, sex, dyslipidemia, hypertension and diabetes mellitus did not significantly affect serum uric acid level at any stage in various ACS patients. Five patients who died during hospital stay, had serum uric acid level more than 7.0 mg/dL and all of them were in KILLIP class III and IV.

Conclusions: serum uric acid level is a strong and independent risk factor in predicting mortality and morbidity profile of patients of acute myocardial infarction. Also, serum uric acid level correlates well with KILLIP class.


Acute coronary syndromes, KILLIP class, Serum uric acid

Full Text:



Alderman MH. Uric acid and cardiovascular risk. Curr Opin Pharmacol. 2002;2(2):126-30.

Bengtsson C, Ladipus L, Stendahl C, Waldenstorm J. Hyperuricaemia and risk of cardiovascular and overall death: A 12-year follow up of participants in the population study of women in Gothenburg, Sweden. Acta Med Scand. 1988;224(6):549-55.

Persky VW, Dyer AR, Idris-Soven E, Stamler J, Shekelle RB, Schoenberger JA et al. Uric acid: a risk factor for coronary heart disease? Circulation 1979;59:969-77.

Kroll KE, Bukowski TR, Schwartz LM, Knoepfler DA, Bassingthwaighte JB. Capillary endothelial transport of uric acid in guinea pig heart. Heart and Circul Physiol. 1992;262(2):H420-31.

Anker SD, Doehner W, Rauchhaus M, Sharma R, Francis D, Knosalla C, et al. Uric acid and survival in chronic heart failure: validation and application in metabolic, functional, and hemodynamic staging. Circulation. 2003;107(15):1991-7.

Ochiai ME, Barretto AC, Oliveira Jr MT, Munhoz RT, Morgado PC, Ramires JA. Uric acid renal excretion and renal insufficiency in decompensated severe heart failure. Eur J Heart Failure. 2005;7(4):468-74.

Kojima S, Sakamoto T, Ishihara M, Kimura K, Miyazaki S, Yamagishi M, et al. Prognostic usefulness of serum uric acid after acute myocardial infarction (the Japanese Acute Coronary Syndrome Study). Am J Cardiol. 2005;96(4):489-95.

Nadkar MY, Jain VI. Serum uric acid in acute myocardial infarction. J Assoc Physicians India. 2008;56(10):759-62.

Tuomilheto J, Zimmet P, Evawolf. Taylor R, Ram P, King H. Plasma Uric acid level and its association with Diabetes Mellitus and some Biologic Parameters in Biracial Population of Fiji. Am J Epidemiol. 1988;127(2):321-36.

Safi AJ, Mahmood R, Khan MA, Haq A. Association of serum Uric Acid with type II diabetes mellitus. J Postgrad Med Inst. 2004;18:59-63.

Cicoira M, Zanolla L, Rossi A, Golia G, Franceschini L, Brighetti G, et al. Elevated Serum Uric acid levels are associated with diastolic dysfunction in patients with dilated cardiomyopathy . Am Heart J. 2002;143(6):1107-11.

Olexa P, Olexova M, Gonsorcik J, Tkác I, Kisel'ová J, Olejníková M. Uric acid a marker for systemic inflammatory response in patients with congestive heart failure? Wien KIin Wochenschr. 2002;114(5-6):211-5.