Association of Uric Acid and C-reactive Protein with the Severity of Coronary Artery Disease Using SYNTAX Score and Clinical SYNTAX Score

  • Yu Xing Department of Cardiovascular, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
  • Jing-Tao Guo Department of Cardiovascular, Chengde Central Hospital, Chengde, China
  • Lu-Yue Gai Department of Cardiovascular, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
  • Bo Liu Department of Cardiovascular, Chengde Central Hospital, Chengde, China
  • Dong-Lei Luo Department of Cardiovascular, Chengde Central Hospital, Chengde, China

Abstract

Background: The SYNTAX score (SXscore), an anatomical-based scoring tool reflecting the complexity of coronary anatomy, has been associated with the mortality and prognosis of coronary artery disease (CAD). Clinical SYNTAX score (CSS), incorporating clinical factors further augmented the utility of the SXscore to longer-term risk. C-reactive protein (CRP) is related to SXscore. Serum uric acid (UA) is associated with atherosclerosis and CAD. However, serum uric acid combined with CRP may better predict the SXscore and CSS.

Methods: A total of 208 patients (mean age 57.82 ± 9.39 years) with chest pain were included in this study. All selected subjects underwent coronary artery angiography and blood test. The relationship between serum UA, CRP and SXscore, and CSS were analyzed.

Results: Age and CRP had a positive correlation with SXs and CSS. DM and fasting glucose correlated with SXscore and CSS respectively. In multivariate regression, serum UA, age, fasting glucose, and body mass index (BMI) were significant discriminant factors of high CSS. The predictive accuracy of CRP for SXscore >0 and high CSS using receiver operator characteristic curves was set at the cut off point of 0.205 mg/dL and 0.145 mg/dL respectively, (sensitivity 70.9% and 98%, specialty 48% and 23.2%).

Conclusion: Serum CRP is correlated with SXscore and CSS, serum UA is independently associated with CSS. CRP predicts high CSS at a lower level than it predicts SXscore. Thus, serum CRP combined with serum UA may be useful to predict SXscore and CSS.

References

Armani A, Becker RC. 2005. The biology, utilization and attenuation of C-reactive protein in cardiovascular disease: part I. Am Heart J 149:971-6.

Capodanno D, Caggegi A, Miano M, et al. 2011. Global risk classification and clinical SYNTAX (Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) score in patients undergoing percutaneous or surgical left main revascularization. J Am Coll Cardiol Interv 4:287-97.

Capodanno D, Di Salvo ME, Cincotta G, Miano M, Tamburino C, Tamburino C. 2009. Usefulness of the SYNTAX score for predicting clinical outcome after percutaneous coronary intervention of unprotected left main coronary artery disease. Circ Cardiovasc Interv 2:302-8.

Chen JH, Chuang SY, Chen HJ, Yeh WT, Pan WH. 2009. Serum uric acid level as an independent risk factor for all-cause, cardiovascular, and ischemic stroke mortality: a Chinese cohort study. Arthritis Rheum 61:225-32.

Chu NF, Wang DJ, Liou SH, Shieh SM. 2000. Relationship between hyperuricemia and other cardiovascular disease risk factors among adult males in Taiwan. Eur J Epidemiol 16:13-7.

Cockcroft DW, Gault MH. 1976. Prediction of creatinine clearance from serum creatinine. Nephron 16:31-41.

Davies KJ, Sevanian A, Muakkassah-Kelly SF, Hochstein P. 1986. Uric acid-iron ion complexes. A new aspect of the antioxidant functions of uric acid. Biochem J 235:747-54.

Dutta A, Henley W, Pilling LC, Wallace RB, Melzer D. 2013. Uric acid measurement improves prediction of cardiovascular mortality in later life. J Am Geriatr Soc 61:319-26.

Ekici B, Kütük U, Alhan A, Töre HF. 2015. The relationship between serum uric acid levels and angiographic severity of coronary heart disease. Kardiol Pol 73:533-8.

Freedman DS, Williamson DF, Gunter EW, Byers T. 1995. Relation of serum uric acid to mortality and ischaemic heart disease. The NHANES I Epidemiologic Follow-up Study. Am J Epidemiol 141:637-44.

Garg S, Sarno G, Garcia-Garcia HM, et al. 2010. A new tool for the risk stratification of patients with complex coronary artery disease: the Clinical SYNTAX Score. Circ Cardiovasc Interv 3:317-26.

Girasis C, Garg S, Räber L, et al. 2011. SYNTAX score and Clinical SYNTAX score as predictors of very long-term clinical outcomes in patients undergoing percutaneous coronary interventions: a substudy of SIRolimus-eluting stent compared with pacliTAXel-eluting stent for coronary revascularization (SIRTAX) trial. Eur Heart J 32:3115-27.

Karadeniz M, Duran M, Akyel A, et al. 2015. High sensitive CRP level is associated with intermediate and high syntax score in patients with acute coronary syndrome. Int Heart J 56:377-80.

Kaya EB, Yorgun H, Canpolat U, et al. 2010. Serum uric acid levels predict the severity and morphology of coronary atherosclerosis detected by multidetector computed tomography. Atherosclerosis 213:178-83.

Kim SY, Guevara JP, Kim KM, Choi HK, Heitjan DF, Albert DA. 2010. Hyperuricemia and coronary heart disease: a systematic review and meta-analysis. Arthritis Care Res (Hoboken) 62:170-80.

Kurtul A, Elcik D. 2017. Procalcitonin is an independent predictor for coronary atherosclerotic burden in patients with stable coronary artery disease. Int J Cardiol 236:61-4.

Labarrere CA, Zaloga GP. 2004. C-reactive protein: from innocent bystander to pivotal mediator of atherosclerosis. Am J Med 117:499-507.

Lai JH, Luo SF, Hung LF, et al. 2017. Physiological concentrations of soluble uric acid arechondroprotective and anti-inflammatory. Sci Rep 7:2359.

Lee J, Sparrow D, Vokonas PS, Landsberg L, Weiss ST. 1995. Uric acid and coronary heart disease risk: evidence for a role of uric acid in the obesity-insulin resistance syndrome: the normative aging study. Am J Epidemiol 142:288-94.

Libby P, Ridker PM, Maseri A. 2002. Inflammation and atherosclerosis. Circulation 105:1135-43.

Lin GM, Li YH, Zheng NC, et al. 2013. Serum uric acid as an independent predictor of mortality in high-risk patients with obstructive coronary artery disease: a prospective observational cohort study from the ET-CHD registry, 1997-2003. J Cardiol 61:122-7.

Pan HC, Sheu WH, Lee WJ, et al. 2015. Coronary severity score and C-reactive protein predict major adverse cardiovascular events in patients with stable coronary artery disease (from the Taichung CAD study). Clin Chim Acta 445:93-100.

Puig JG, Ruilope LM. 1999. Uric acid as a cardiovascular risk factor in arterial hypertension. J Hypertens 17:869-72.

Raeisi A, Ostovar A, Vahdat K, et al. 2017. Association of serum uric acid with high-sensitivity C-reactive protein in postmenopausal women. Climacteric 20:44-8.

Ruggiero C, Cherubini A, Ble A, et al. 2006. Uric acid and inflammatory markers. Eur Heart J 27:1174-81.

Serruys PW, Onuma Y, Garg S, et al. 2009. Assessment of the SYNTAX score in the Syntax study. Euro Intervention 5:50-6.

Serruys PW, Onuma Y, Garg S, et al. 2010. 5-year clinical outcomes of the ARTS II (Arterial Revascularization Therapies Study II) of the sirolimus-eluting stent in the treatment of patients with multivessel de novo coronary artery lesions. J Am Coll Cardiol 55:1093-101.

Sianos G, Morel MA, Kappetein AP, et al. 2005. The SYNTAX score: an angiographic tool grading the complexity of coronary artery disease. Euro Intervention 1:219-27.

Sinan Deveci O, Kabakci G, Okutucu S, et al. 2010. The association between serum uric acid level and coronary artery disease. Int J Clin Pract 64:900-7.

Spiga R, Marini MA, Mancuso E, et al. 2017. Uric acid is associated with inflammatory biomarkers and induces inflammation via activating the NF-κB signaling pathway in HepG2 cells. Arterioscler Thromb Vasc Biol 37:1241-9.

Sun H, Koike T, Ichikawa T, et al. 2005. C-reactive protein in atherosclerotic lesions: its origin and pathological significance. Am J Pathol 167:1139-48.

SYNTAX score calculator. 2013. Available at: http://www.syntaxscore.com. SYNTAX working-group. Accessed May 2018.

Taniguchi H, Momiyama Y, Ohmori R, et al. 2005. Associations of plasma C-reactive protein levels with the presence and extent of coronary stenosis in patients with stable coronary artery disease. Atherosclerosis 178:173-7.

Tanveer S, Banu S, Jabir NR, et al. 2016. Clinical and angiographic correlation of high-sensitivity C-reactive protein with acute ST elevation myocardial infarction. Exp Ther Med 12:4089-98.

Wykrzykowska JJ, Garg S, Girasis C, et al. 2010. Value of the syntax score for risk assessment in the All-Comers population of the randomized multicenter LEADERS trial. J Am Coll Cardiol 56:272-7.

Wykrzykowska JJ, Garg S, Onuma Y, et al. 2011. Value of age, creatinine, and ejection fraction (ACEF score) in assessing risk in patients undergoing percutaneous coronary interventions in the All-Comers LEADERS trial. Circ Cardiovasc Interv 4:47-56.

Xiong Z, Zhu C, Qian X, Zhu J, Wu Z, Chen L. 2011. Predictors of clinical SYNTAX score in coronary artery disease: serum uric acid, smoking, and Framingham risk strati cation. J Invasive Cardiol 23:501-4.

Yeh ET, Willerson JT. 2003. Coming of age of C-reactive protein: using inflammation markers in cardiology. Circulation 107:370-1.

Yildiz A, Kaya Z. 2012. Uric acid: a crucial marker of cardiovascular diseases? Int J Cardiol 159:158.

Yu J, Han J, Mao J. 2014. Association between serum uric acid level and the severity of coronary artery disease in patients with obstructive coronary artery disease. Chin Med J (Engl) 127:1039-45.

Published
2019-06-03
Section
Articles