The Influence of Serum Uric Acid on Risks of Major Adverse Cardiovascular Events in Patients with Acute Coronary Syndrome

The Influence of Serum Uric Acid on Risks of Major Adverse Cardiovascular Events in Patients with Acute Coronary Syndrome | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Influence of Serum Uric Acid on Risks of Major Adverse Cardiovascular Events in Patients with Acute Coronary Syndrome Cheng-Hung Chiang, Mei-Chi Wang, En-Shao Liu, Tse-Hsuan Yang, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7514499/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 25 Nov, 2025 Read the published version in BMC Cardiovascular Disorders → Version 1 posted 10 You are reading this latest preprint version Abstract Background: Acute coronary syndrome (ACS) is a major cause of morbidity and mortality worldwide. Identifying biomarkers that predict outcomes is essential for guiding management. This study evaluated whether elevated serum uric acid (SUA) is associated with increased risks of major adverse cardiovascular events (MACE), recurrent myocardial infarction (re-MI), and all-cause mortality (ACM) in patients with ACS. Methods: This retrospective cohort study enrolled 829 inpatients with ACS admitted to a tertiary referral hospital in Taiwan from 2015 to 2019. Patients were divided into normal (< 7.25 mg/dL, n = 566) and high (≥ 7.25 mg/dL, n = 263) SUA groups based on a receiver operating characteristic–derived cutoff. All patients received standard ACS care, and SUA levels were retrospectively analyzed. The primary outcome was major adverse cardiovascular events (MACE), defined as all-cause mortality (ACM), re-MI, and target lesion/vessel revascularization (TLR/TVR), assessed up to 60 months. Kaplan–Meier survival analysis, logistic regression, and Cox proportional hazards regression were applied. Results: The overall rates of MACE (19.54%), re-MI (2.9%), and ACM (4.46%) were higher in the high SUA group compared with the normal SUA group (MACE: 26.62% vs. 16.25%, p = 0.0005; re-MI: 6.08% vs. 1.41%, p = 0.0002; ACM: 7.22% vs. 3.18%, p = 0.0087). No significant difference was observed in TLR/TVR (11.94%) between groups (11.48% vs. 12.93%, p = 0.5508). Kaplan–Meier analysis at 60 months showed higher event-free rates for MACE, re-MI, and ACM in the normal SUA group (log-rank p = 0.0117, 0.0006, and 0.0261, respectively). Multivariable logistic regression demonstrated an association between SUA ≥ 7.25 mg/dL and increased MACE (odds ratio = 1.639, 95% confidence interval [CI] = 1.084–2.477, p = 0.0191). Cox regression revealed higher risks of MACE (hazard ratio [HR] = 1.399, 95% CI = 1.024–1.191, p = 0.0350), re-MI (HR = 3.758, 95% CI = 1.605–8.799, p = 0.0023), and ACM (HR = 1.956, 95% CI = 1.019–3.753, p = 0.0438) in the high SUA group after adjustment for age, uremia, drug-eluting stent, and number of diseased vessels. Conclusions: Elevated SUA is associated with increased risks of MACE, re-MI, and ACM in patients with ACS. Routine SUA assessment may help identify high-risk individuals for closer monitoring and tailored management. Clinical trial number: Not applicable. Serum Uric Acid Major Adverse Cardiovascular Events Recurrent Myocardial Infarction Acute Coronary Syndrome Figures Figure 1 Figure 2 Figure 3 Background Acute coronary syndrome (ACS), which is one of the leading causes of death and disability worldwide, has become a global health care burden.[ 1 ] In patients with ACS, identifying biomarkers that can predict future cardiovascular risk is crucial for improving clinical outcomes and guiding therapeutic interventions. Serum uric acid (SUA) has gained attention as one such biomarker, with a growing body of evidence suggesting that elevated SUA levels may be associated with adverse cardiovascular outcomes, including major adverse cardiovascular events (MACE), myocardial infarction (MI), and mortality.[ 2 , 3 ] Recurrent MI (re-MI) is one of the most common adverse cardiovascular events that may occur after an episode of ACS. According to the fourth universal definition of myocardial infarction, re-MI refers to MI that occurs beyond 28 days following the index MI event.[ 4 ] Due to its frequent occurrence and prognostic implications, re-MI is routinely included in the composite outcome of MACE among studies targeting patients with ACS. Therefore, re-MI and other MACE tend to share many common risk factors.[ 5 ] A recent study revealed a rate of re-MI within one year after the initial MI of up to 2.5% together with a high mortality rate of 53.3%.[ 6 ] Studies about re-MI rate and MACE with longer follow-up after ACS was relative scarce. Uric acid, the end-product of purine metabolism, has been implicated in various pathological processes linked to cardiovascular disease. Previous studies have shown that elevated SUA is associated with endothelial dysfunction, oxidative stress, and chronic inflammation, all of which are key mechanisms underlying the pathogenesis of atherosclerosis and coronary artery disease.[ 7 , 8 ] Hyperuricemia has also been found to increase the risk of hypertension, chronic kidney disease (CKD), and metabolic syndrome, further compounding its potential as a cardiovascular risk factor.[ 9 , 10 ] Despite the known associations, the clinical significance of SUA in ACS patients remains a topic of ongoing research. Some studies suggest that elevated SUA is an independent predictor of adverse cardiovascular events, while others argue that it is merely a marker of other risk factors such as chronic kidney disease and metabolic dysfunction.[ 11 – 15 ] Recent studies have also examined the role of SUA as a prognostic factor in various cardiovascular contexts, further suggesting its clinical relevance in risk assessment.[ 16 , 17 ] Although numerous investigations have linked hyperuricemia to short-term mortality and MACE after ACS, most published cohorts were Western, had follow-up limited to ≤ 12 months, and treated re-MI only as part of a composite endpoint. To our knowledge, no East-Asian study has examined long-term (up to 5 years) outcomes while separating re-MI from the broader MACE construct. Moreover, existing reports usually apply arbitrary sex-based uric-acid thresholds; few have derived an optimal cut-off directly from their own data. Accordingly, the present study (i) follows a large Taiwanese ACS cohort for as long as 60 months, (ii) evaluates re-MI as an independent endpoint alongside traditional MACE components, and (iii) employs a receiver-operating-characteristic (ROC) approach to generate a population-specific cut-off for high SUA. These features allow us to re-examine the prognostic role of SUA in a contemporary East-Asian setting and to provide clinicians with a data-driven threshold that may be more applicable than historical reference values. Methods Study design and setting The present retrospective cohort study focused on inpatients diagnosed with ACS at a single tertiary referral hospital between January 1, 2015 and December31, 2019. All follow up was passive and based on retrospective review of our hospital’s medical records; no telephone calls, clinic visits scheduled for research, or external registry linkages were used. After discharge, patients were given routine cardiology appointments at 1 week, 1 month, and every 3 months thereafter, with earlier visits if new symptoms occurred. At each visit the cardiologist recorded clinical status and any interim cardiovascular events; any readmissions were captured in the same medical records. The length of observation for each patient—from discharge to the last documented clinic visit or readmission—was extracted from the medical record. Of the 1,949 patients admitted for ACS during the study period, 174 expired during index hospitalization and 899 were excluded because of incomplete SUA data, 42 with the use of oral anticoagulants or warfarin were deemed ineligible and excluded to avoid confounding, as these individuals often had comorbid conditions (such as atrial fibrillation or mechanical heart valves) affecting outcomes, and 5 were omitted as a consequence of loss to follow-up. Finally, 829 patients were enrolled in this study. ( Figure 1 ) The protocol and procedures of the current study were reviewed and approved by the institutional review board (IRB) of our institute (No. VGHKS20-CT7-22). Study parameters Baseline characteristics [i.e., age, body-mass index (BMI), sex, and comorbidities], clinical and laboratory data on admission [i.e., left-ventricular ejection fraction (LVEF), SUA, glycated hemoglobin (HbA1c), estimated glomerular filtration rate (eGFR), total cholesterol, including high-density lipoprotein (HDL) and low-density lipoprotein (LDL), triglyceride, and peak values of creatine kinase (CK), creatine kinase MB (CK-MB), and high-sensitivity Troponin I], types of ACS [ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina], number of diseased vessels, type of coronary artery disease(CAD) [single vessel disease (SVD), double vessel disease (DVD), or triple vessel disease (TVD)], implanted stents [bare-metal stent (BMS) or drug-eluting stent (DES)] and discharge medications after ACS [i.e., anti-platelets, beta blockers, statins, angiotensin II receptor blockers (ARBs) or angiotensin-converting enzyme inhibitors (ACEIs)], and data on hospital re-admission were retrospectively collected from the patients’ medical records. SUA was not part of standard ACS admission panel during the study years. Whether SUA was measured depended on the attending cardiologist. Definitions MACE was defined as the composite outcome of all-cause mortality (ACM), re-MI, and target lesion revascularization/target vessel revascularization (TLR/TVR) up to 60-month follow-up after percutaneous coronary intervention (PCI). Receiver operating characteristic (ROC) curve and area under curve (AUC) were used to determine the correlation between serum uric acid concentration and the risk of MACE. The optimal cutoff SUA level was 7.25 mg/dL, which yielded a sensitivity of 43.9% and specificity of 70.4% for predicting 60-month MACE in our cohort. ( Figure 2 ) The eligible patients were further divided into normal SUA group (defined as SUA level <7.25 ng/mL) and high SUA group (defined as SUA level ≥7.25 ng/mL). Statistical Analyses Continuous variables and categorical variables are shown as mean ± standard deviation and number with percentage (n, %), respectively. Independent sample t tests and Chi-squared tests were performed to determine the significance of difference in patient characteristics, laboratory findings, medications, and the incidence of re-admission between the normal and high SUA groups. Kaplan-Meier survival analysis was conducted to compare the survival probability of MACE between the two groups. To identify significant risk factors, we used logistic regression to assess the association between patient characteristics and MACE expressed as odds ratio (OR) and 95% confidence interval (CI). Furthermore, we evaluated the hazard ratio (HR) and 95% CI between the patients’ SUA level and their MACE outcomes with Cox proportional hazards regression, which can be used for survival-time (time-to-event) outcomes on one or more predictors. A p value of less than 0.05 was considered statistically significant. All statistical analyses were conducted with the software IBM SPSS 22.0 and SAS 9.4. Results Of the 829 eligible patients, 566 were assigned to the normal SUA group (i.e., SUA level <7.25 ng/mL) and 263 fit the recruitment criterion for the high SUA group (i.e., SUA ≥7.25 ng/mL). The flowchart of enrollment is presented in Figure 1 . Median follow-up for the whole cohort was 12.0 months [inter-quartile range (IQR) 4.41–27.09; 365 days (IQR 134–824)]. In the normal-UA group the median was 11.18 months [IQR 4.37–24.66; 340 days (133–750)], whereas the high-UA group was followed slightly longer, 13.91 months [IQR 4.53–29.56; 423 days (138–899)]. Approximately one quarter of patients contributed follow-up beyond 27 months and 121 patients over 3 years. The baseline characteristics of all participants are listed in Table 1 . The proportion of male patients in the high SUA group was higher than that in the normal SUA group (88.59% vs. 83.32%, p =0.0440), while the latter had lower SUA (5.50 ± 1.12 vs. 8.82 ± 1.48, p <0.0001), higher eGFR (68.10 ± 25.01 vs. 51.00 ± 25.76, p <0.0001), HDL concentration (40.09 ± 9.80 vs. 37.86 ± 9.49, p =0.0033) and LVEF (51.72±7.99 vs. 48.49±9.38, p <0.0001) compared with the former. Regarding comorbidities, patients in the normal SUA group showed a lower prevalence of hypertension (43.82% vs. 56.27%, p =0.0008), diabetes mellitus (33.57% vs. 41.83%, p =0.0213), CKD (5.30% vs. 20.15%, p <0.0001), heart failure (10.78% vs. 16.35%, p =0.0242), and gout (7.60% vs. 18.63%, p <0.0001) than those in the high SUA group. Focusing on the type of ACS, patients in the normal SUA group exhibited more STEMI (54.95% vs. 43.35%), less NSTEMI (43.64% vs. 53.99%) and unstable angina (1.41% vs. 2.66%) compared with their high SUA counterparts ( p = 0.0056). In respect of medications, patients in the normal SUA group had higher rates of receiving P2Y12 (98.23% vs. 95.82%, p =0.0394) and dual-antiplatelet therapy (93.64% vs. 92.02%, p =0.0496) than those in the high SUA group. The cardiovascular events of the two groups are summarized in Table 2 . The overall MACE rate of all the patients was 19.54%. It was lower in the normal SUA group than that in the high SUA group (16.25% vs. 26.62%, respectively, p =0.0005). Regarding the need for revascularization, the overall TLR/TVR rate was 11.94% without significant differences between the two groups (11.48% vs. 12.93%, p =0.5508). In addition, the re-MI rate was lower in the normal SUA group than that in the high SUA group (1.41% vs. 6.08%, respectively, p =0.0002), giving an overall rate of 2.90%. The ACM rate of the participants in the normal SUA group was lower than that in those with high SUA (3.18% vs. 7.22%, p =0.0087), with the overall rate being 4.46%. Kaplan-Meier event-free survival analysis of MACE, TLR/TVR, re-MI, and ACM up to 60 months of follow-up is shown in Figure 3 . Compared with the high SUA group, the MACE, re-MI, and ACM rates were all significantly lower in the normal SUA group with log-rank p values of 0.0117, 0.0006, and 0.0261, respectively. On the other hand, no significant difference was noted in the TLR/TVR rate between the two groups (log-rank p value of 0.8691). The association between patients’ characteristics and MACE by univariable and multivariable logistic regression is demonstrated in Table 3 . Univariable logistic regression analysis revealed a correlation between an increased MACE rate with age (OR: 1.025, 95% CI 1.012 to 1.038, p <0.0001), SUA ≥ 7.25 ng/mL (OR: 1.869, 95% CI 1.313 to 2.660, p =0.0005), SUA (OR: 1.159, 95% CI 1.066 to 1.259, p =0.0005), the presence of hypertension (OR: 1.837, 95% CI 1.295 to 2.604, p =0.0006), diabetes mellitus (OR: 1.694, 95% CI 1.196 to 2.399, p =0.0030), CKD (OR: 2.475, 95% CI 1.518 to 4.035, p =0.0003), uremia (OR: 4.607, 95% CI 2.482 to 8.552, p <0.0001), heart failure (OR: 2.147, 95% CI 1.363 to 3.384, p =0.0010), atrial fibrillation (OR: 2.526, 95% CI 1.468 to 4.347, p =0.0008), number of diseased vessels (OR: 1.748, 95% CI 1.405 to 2.174, p <0.0001) and the use of BMS (OR: 1.720, 95% CI 1.206 to 2.451, p =0.0027). On the other hand, LVEF (OR: 0,974, 95% CI 0.953 to 0,996, p =0.0211) and the use of DES (OR: 0.508, 95% CI 0.359 to 0.719, p =0.0001) were associated with a lower MACE rate. The backward stepwise multiple logistic regression models to predict MACE were performed and factors such as age, SUA (≥7.25 mg/dL), LVEF, hypertension, diabetes mellitus, chronic kidney insufficiency, uremia, heart failure, atrial fibrillation, BMS, DES and number of diseased vessels were selected. ( Supplementary Table ) Multivariable logistic regression analysis identified age (OR: 1.019, 95% CI 1.005 to 1.034, p =0.0087), SUA ≥7.25 ng/mL (OR: 1.639, 95% CI 1.084 to 2.477, p =0.0191), uremia (OR: 2.692, 95% CI 1.245 to 5.802, p =0.0118), number of diseased vessels(OR: 1.716, 95% CI 1.334 to 2.208, p <0.0001) as significant predictors of increased MACE rates and the use of DES (OR: 0.591, 95% CI 0.394 to 0.888, p =0.0114) significantly decrease MACE rate. The HRs by COX regression models to predict CV events based on SUA are summarized in Table 4 . Before adjustment with patients having a SUA concentration <7.25 ng/mL that served as the reference group, the rates of MACE (HR: 1.489, 95% CI 1.090 to 2.033, p =0.0123), re-MI (HR: 3.935, 95% CI 1.683 to 9.203, p =0.0016), and ACM (HR: 2.049, 95% CI 1.074 to 3.907, p =0.0294) were higher in patients with an elevated SUA level than those with a normal SUA concentration. After adjusting for age, uremia, DES, and number of diseased vessels, as well as patients with normal SUA concentrations serving as the reference group, the rates of MACE (HR: 1.399, 95% CI 1.024 to 1.912, p =0.0350), re-MI (HR: 3.758, 95% CI 1.605 to 8.799, p =0.0023) and ACM (HR: 1.956, 95% CI 1.019 to 3.753, p =0.0438) were significantly higher in the high SUA group than that in the normal SUA group. Discussion In this retrospective single-center cohort, we found that patients admitted with ACS who had high SUA were more likely to develop adverse events, even after full adjustment for clinical and procedural factors. Our study stands out because we followed an East-Asian population for up to five years, treated re-MI as a separate outcome and showed it was more than three times as common in the high SUA group, and determined a data-driven cut-off value of 7.25 mg/dL rather than relying on traditional laboratory thresholds. Together, these results confirm the prognostic importance of SUA and offer a practical, locally derived threshold that may help clinicians identify higher-risk ACS patients. Our findings are consistent with those of previous studies that explored the prognostic value of SUA in cardiovascular disease. For instance, a prior meta-analysis showed an increased risk of MACE (RR: 1.86; 95% CI: 1.47–2.35), and ACM (RR 1.86; 95% CI: 1.49–2.32) in ACS patients with concomitant hyperuricemia after adjustment for the conventional risk factors.[ 18 ] Another meta-analysis reported an elevated incidence of short-term (RR = 1.46, 95% CI: 1.40–1.51) and long-term (RR = 1.43, 95% CI: 1.35–1.52) MACE as well as re-MI (RR = 1.49, 95% CI: 1.06–2.10) in patients diagnosed with MI and elevated SUA levels.[ 19 ] In concert with these findings, a prior study further revealed a positive correlation between SUA concentration and six-month fatal reinfarction in individuals with elevated UA levels compared with those with normal UA concentrations (9.8% vs. 2.7%, p = 0.002), ACM (19.6 vs. 4.1, p < 0.001) and MACE (26.6% vs. 11%, p < 0.001).[ 20 ] Re-MI, which is not uncommon following ACS, contributed to a significant increase in risks of subsequent cardiovascular events and mortality.[ 21 ] Due to its frequent occurrence and prognostic implications, re-MI is routinely included as a component of the composite outcome of MACE in studies focusing on patients with ACS.[ 5 ] Conceivably, re-MI and other MACE are known to share a number of common risk factors, including age, female sex, prior MI, prior stroke, diabetes, left ventricular dysfunction, failed or not attempted revascularization, high Killip class, low systolic blood pressure, and renal failure.[ 21 ] Previous studies have investigated the usefulness of biomarkers in the predication of re-MI. While one study reported the absence of specific biomarker in this setting [ 22 ], a meta-analysis identified C-reactive protein (CRP) as a predictor of re-MI (OR: 1.76, 95% CI: [1.28, 2.43], p < 0.001) in patients with AMI undergoing PCI.[ 23 ] In addition, another study demonstrated the reliability of high-sensitivity troponins (hs-cTnT and hs-cTnI) as biomarkers of recurrent cardiovascular events.[ 24 ] Focusing on SUA, our data revealed significantly higher rates of re-MI (HR: 3.758, 95% CI 1.605 to 8.799, p = 0.0023) in ACS patients with elevated SUA levels compared to those with normal SUA concentrations after adjusting for age, uremia, DES, and number of diseased vessels. Consistently, a previous clinical study recruiting 1215 patients reported a 1.5-fold increased risk of MI ( p = 0.032) among patients with hyperuricemia compared to those without over a mean follow-up period of 5.5 years.[ 25 ] The results of our study suggested that a high SUA concentration could be a significant prognostic factor for re-MI and MACE after up to five years of follow-up. Unlike the earlier study using fixed UA thresholds (i.e., ≥ 7.0 mg/dL for men and ≥ 6.0 mg/dL for women), the current study employed a data-driven approach by utilizing a ROC curve to determine a cutoff value (≥ 7.25 mg/dL) to enhance the precision of our findings and improve their applicability to our specific patient population. Besides, our study further included re-MI as a distinct endpoint in an attempt to shed light on the association of SUA on the risk of ACS-related adverse cardiovascular outcomes, particularly re-MI. Hyperuricemia has been linked to increased oxidative stress, impaired endothelial function, and activation of the renin-angiotensin system, which can exacerbate the progression of atherosclerosis.[ 26 , 27 ] Moreover, provided that chronic kidney disease is a well-known independent risk factor for cardiovascular events, hyperuricemia may increase cardiovascular risk through impairing kidney function.[ 28 , 29 ] Additionally, the association of hyperuricemia with other metabolic abnormalities, such as insulin resistance and metabolic syndrome, further highlights its importance as a marker of cardiovascular risk.[ 10 , 30 ] Other possible mechanisms that may be associated with uric acid-related increase in risk of adverse cardiovascular outcomes also include inflammation induction and endothelial damage as demonstrated in previous studies that investigated the long-term cardiovascular outcomes of patients following ACS. [ 31 , 32 ] Due to a lack of consensus on the cardiovascular cutoff value for hyperuricemia, the definition varied in different studies. While two studies used SUA > 7 mg/dL in males and > 6 mg/dL in females as cutoff values,[ 33 , 34 ] one study adopted SUA > 8 mg/dL in men and > 7.5 mg/dL in women.[ 15 ] Other studies used either > 6.2 mg/dL, > 6.5 mg/dl, or ≥ 6.8 mg/dL as cutoff values.[ 32 , 35 – 37 ] The cutoff value for hyperuricemia in the current study was SUA ≥ 7.25 mg/dL according to the ROC curve for MACE prediction in our study population (Fig. 2 ). The slight differences between studies likely reflect population differences (ACS severity, comorbidities) and endpoints considered. Our cutoff is in line with the general range identified in literature, which reinforces its clinical plausibility. At the same time, our findings echo the point made in a recent review: different studies have found dissimilar UA cut-offs for cardiovascular risk, and none have been universally validated.[ 38 ] This suggests that while hyperuricemia is undoubtedly a risk marker, the exact threshold for high risk may need tailoring to specific patient groups. Our study found no significant difference in the TLR/TVR rates between the normal and high SUA groups (11.48% vs. 12.93%, respectively, p = 0.5508). Previous studies reported inconsistent results regarding the association of SUA on the risk of coronary arterial restenosis after PCI. A prior clinical investigation analyzing the association of hyperuricemia on the long-term risk of in-stent restenosis (ISR) among patients after PCI showed similar degree of late lumen loss (0.8 ± 0.9 mm vs. 0.8 ± 1.1 mm, p = 0.895) and rate of binary restenosis (28.1% vs. 34.7%, p = 0.622) between patients with and without hyperuricemia.[ 39 ] In contrast, another study proposed that elevated preprocedural SUA could be a powerful and independent predictor of BMS restenosis in patients with stable and unstable angina pectoris (23% in the lowest tertile, 34% in the middle tertile, and 46% in the highest tertile, p < 0.001).[ 40 ] Likewise, a clinical study assessing the association between the uric acid to albumin ratio (UAR) and the incidence of ISR concluded that UAR was positively associated with the risk of ISR in patients with CAD undergoing PCI with DES implantation.[ 41 ] Pathophysiologically, ISR is considered to be the result of natural inflammatory responses after stent implantation. Accordingly, previous studies have shown a positive association of high-sensitivity C-reactive protein (hsCRP) and other inflammatory biomarkers with ISR and poor clinical outcomes after DES implantation.[ 42 – 45 ] Being the first investigation into the association of SUA on the risk of long-term TLR/TVR in patients diagnosed with ACS, the current study showed no significant difference between participants with hyperuricemia and those without. Other well-known risks factors, such as the type, size, and number of stent being implanted, complexity of coronary arterial lesions, and serum lipid profile, as well as the presence of diabetes mellitus and chronic kidney disease, may have a more significant association on long-term TLR/TVR than SUA in patients having experienced ACS.[ 39 ] Nevertheless, our findings suggested that routine assessment of SUA levels in patients diagnosed with ACS could aid in identifying those at risk of adverse cardiovascular outcomes, thereby allowing for timely and targeted therapeutic interventions. Strengths and Limitations This study had several strengths. First, it was based on a relatively large cohort of patients with ACS, thereby enabling a robust analysis of the association between SUA levels and cardiovascular outcomes. Second, the use of multivariate analysis adjusted for known cardiovascular risk factors such as age, kidney function, and atrial fibrillation strengthens the validity of our findings by minimizing potential confounding effects. Third, a follow-up of up to 60 months allowed the gaining of valuable insights into the long-term prognostic value of SUA, thereby providing real-world information for improving the clinical care of patients having experienced ACS. However, this study also had its limitations. First, this was a retrospective study from a single center; while the uniform treatment protocols and complete electronic records enhance internal consistency, the findings may not be generalizable to other settings. Future multi-center, prospective studies are needed to confirm these results. Second, the retrospective nature of the study rendered it susceptible to selection bias and potential confounders that were not measured or controlled for. Third, while we adjusted several key variables, there could be residual confounding effects from unmeasured factors such as diet, physical activity, and genetic predispositions, which could influence both SUA levels and cardiovascular outcomes. Fourth, there was a lack of information on pharmacological interventions that may affect SUA levels (e.g., urate-lowering therapies) and alter the risk of cardiovascular events. Fifth, because SUA testing was left to each physician’s discretion and was not routine, almost half of the original ACS admissions lacked SUA value and had to be excluded. This discretionary ordering may introduce selection bias. Conclusions The findings of our study add to the growing body of evidence that supports a positive association between hyperuricemia and an increased risk of MACE, re-MI and ACM events in patients with ACS, suggesting the potential benefit of routine SUA assessment in the identification of patients experiencing ACS at risk of adverse cardiovascular outcomes to tailor individualized treatment strategies. Abbreviations ACS, acute coronary syndrome; ACM, all-cause mortality; AUC, area under the curve; BMI, body mass index; BMS, bare-metal stent; CAD, coronary artery disease; CI, confidence interval; CK, creatine kinase; CK-MB, Creatine kinase MB; CKD, chronic kidney disease; CRP, C-reactive protein; DES, drug-eluting stent; eGFR, estimated glomerular filtration rate; HbA1c, glycated hemoglobin; HDL, high-density lipoprotein; HR, hazard ratio; hs-CRP, high-sensitivity C-reactive protein; hs-cTnI, high-sensitivity troponin I; hs-cTnT, high-sensitivity troponin T; IQR, interquartile range; ISR, in-stent restenosis; LVEF, left ventricular ejection fraction; MACE, major adverse cardiovascular events; MI, myocardial infarction; NSTEMI, non–ST elevation myocardial infarction; OR, odds ratio; PCI, percutaneous coronary intervention; ROC, receiver operating characteristic; STEMI, ST elevation myocardial infarction; SUA, serum uric acid; TLR, target lesion revascularization; TVR, target vessel revascularization; and UAR, uric acid to albumin ratio. Declarations Ethics approval and consent to participate T his study was approved by the Institutional Review Board of Kaohsiung Veterans General Hospital, Taiwan (Approval No. VGHKS20-CT7-22). As this was a retrospective study using anonymized data, the requirement for informed consent was waived by the ethics committee. Consent for publication Not applicable. Availability of data and materials The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors’ contributions CHC conceived the study, collected and analyzed the data, and drafted the manuscript. MCW performed statistical analyses. ESL, TSY, HTT, and JFH contributed to data collection, interpretation, and critical revision of the manuscript. 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Demographic statistics between normal and high serum uric acid groups Total Serum Uric Acid (SUA) p -value SUA < 7.25 mg/dL SUA ≥ 7.25 mg/dL N=829 N=566 N=263 Characteristics Age (years) 61.89±14.10 61.41±13.78 62.91±14.76 0.1545 BMI (kg/m 2 ) 25.59±3.91 25.46±3.70 25.87±4.32 0.1839 Sex 0.0440 Male 704 (84.92) 471 (83.22) 233 (88.59) Female 125 (15.08) 95 (16.78) 30 (11.41) Laboratory data and examination on admission Serum uric acid (mg/dL) 6.55±1.98 5.50±1.12 8.82±1.48 <.0001 eGFR (ml/min/1.73) 62.68±26.46 68.10±25.01 51.00±25.76 <.0001 TG (mg/dL) 129.31±103.24 126.39±102.99 135.95±103.75 0.2672 Total cholesterol (mg/dL) 176.08±46.18 174.72±44.55 179.00±49.45 0.2376 HDL (mg/dL) 39.40±9.75 40.09±9.80 37.86±9.49 0.0033 LDL (mg/dL) 108.21±39.70 108.36±39.29 107.87±40.65 0.8750 HbA1c (%) 7.00±1.93 6.98±1.95 7.06±1.88 0.5939 CK (U/L) 1531.11±1939.97 1513.42±1696.54 1569.04±2382.86 0.7337 CK-MB (U/L) 129.21±148.37 130.59±136.92 126.25±170.73 0.7197 High-sensitive Troponin I (pg/mL) 68.14±263.30 59.33±127.54 87.15±428.70 0.3115 LVEF (%) 50.69±8.58 51.72±7.99 48.49±9.38 <.0001 Comorbidities Hypertension 396 (47.77) 248 (43.82) 148 (56.27) 0.0008 Diabetes mellitus 300 (36.19) 190 (33.57) 110 (41.83) 0.0213 Chronic kidney insufficiency 83 (10.01) 30 (5.30) 53 (20.15) <.0001 Uremia 44 (5.31) 28 (4.95) 16 (6.08) 0.4969 Hypercholesterolemia 259 (31.24) 174 (30.74) 85 (32.32) 0.6484 Heart failure 104 (12.55) 61 (10.78) 43 (16.35) 0.0242 Atrial fibrillation 64 (7.72) 46 (8.13) 18 (6.84) 0.5195 CVA 28 (3.38) 19 (3.36) 9 (3.42) 0.9614 Gout 92 (11.10) 43 (7.60) 49 (18.63) <.0001 Type of ACS 0.0056 STEMI 425 (51.27) 311 (54.95) 114 (43.35) NSTEMI 389 (46.92) 247 (43.64) 142 (53.99) Unstable angina 15 (1.81) 8 (1.41) 7 (2.66) Numbers of diseased vessels 2.08±0.85 2.05±0.86 2.14±0.84 0.1360 Type of CAD 0.2784 SVD 271 (32.69) 195 (34.45) 76 (28.90) DVD 224 (27.02) 150 (26.50) 74 (28.14) TVD 334 (40.29) 221 (39.05) 113 (42.97) Implemented stent BMS 261 (31.48) 174 (30.74) 87 (33.08) 0.5000 DES 465 (56.09) 323 (57.07) 142 (53.99) 0.4064 Medications at discharge Aspirin 787 (94.93) 537 (94.88) 250 (95.06) 0.9121 P2Y12 inhibitor 808 (97.47) 556 (98.23) 252 (95.82) 0.0394 DAPT 772 (93.12) 530 (93.64) 242 (92.02) 0.0496 Beta blocker 551 (66.47) 378 (66.78) 173 (65.78) 0.7755 Statin 709 (85.52) 487 (86.04) 222 (84.41) 0.5343 ACEI/ARB 485 (58.50) 321 (56.71) 164 (62.36) 0.1248 BMI, body mass index; eGFR, estimated glomerular filtration rate; TG, triglyceride; HDL, high density lipoprotein; LDL, low density lipoprotein; HbA1c, glycated hemoglobin; CK, creatine kinase; CK-MB, creatine kinase MB; LVEF, left ventricular ejection fraction; CVA, cerebrovascular accident; ACS, acute coronary syndrome; STEMI, ST elevated myocardial infarction; NSTEMI, non-ST elevated myocardial infarction; CAD, coronary artery disease; SVD, single vessel disease; DVD, double vessel disease; TVD, triple vessel disease; BMS, bare-metal stent; DES, drug-eluting stent; DAPT, dual antiplatelet therapy; and ACEI/ARB, angiotensin converting enzyme inhibitor/angiotensin II receptor blocker Table 2. Event rates during follow up between normal and high SUA groups. Total Serum Uric Acid (SUA) p -value SUA<7.25 mg/dL SUA≥7.25 mg/dL n (%) N=829 N=566 N=263 MACE 162 (19.54) 92 (16.25) 70 (26.62) 0.0005 TVR/TLR 99 (11.94) 65 (11.48) 34 (12.93) 0.5508 re-MI 24 (2.90) 8 (1.41) 16 (6.08) 0.0002 ACM 37 (4.46) 18 (3.18) 19 (7.22) 0.0087 MACE, major adverse cardiovascular event; TVR, target vessel revascularization; TLR, target lesion revascularization; MI, myocardial infarction; and ACM, all-cause mortality. Table 3. Univariable and multivariable logistic regression models to predict major adverse cardiovascular events. Univariable model Multivariable model* OR 95% CI p -value OR 95% CI p -value Age 1.025 1.012 1.038 <.0001 1.019 1.005 1.034 0.0087 BMI 0.977 0.935 1.022 0.3157 Male 0.731 0.465 1.148 0.1736 SUA ≥7.25 mg/dL 1.869 1.313 2.660 0.0005 1.639 1.084 2.477 0.0191 SUA 1.159 1.066 1.259 0.0005 LVEF 0.974 0.953 0.996 0.0211 Hypertension 1.837 1.295 2.604 0.0006 Diabetes mellitus 1.694 1.196 2.399 0.0030 Chronic kidney insufficiency 2.475 1.518 4.035 0.0003 Uremia 4.607 2.482 8.552 <.0001 2.692 1.245 5.820 0.0118 Hypercholesterolemia 1.051 0.727 1.518 0.7932 Heart failure 2.147 1.363 3.384 0.0010 Atrial fibrillation 2.526 1.468 4.347 0.0008 CVA 2.006 0.890 4.521 0.0930 Type of ACS during admission STEMI 0.452 0.139 1.466 0.1859 NSTEMI 0.926 0.288 2.975 0.8974 Unstable angina Ref. Number of diseased vessels 1.748 1.405 2.174 <.0001 1.716 1.334 2.208 <.0001 Stent (BMS/DES) 0.752 0.494 1.145 0.1844 BMS 1.720 1.206 2.451 0.0027 DES 0.508 0.359 0.719 0.0001 0.591 0.394 0.888 0.0114 Aspirin 0.669 0.329 1.361 0.2670 P2Y12 inhibitor 1.033 0.343 3.112 0.9543 DAPT 0.728 0.388 1.366 0.3234 Beta blocker 0.944 0.658 1.356 0.7561 Statin 0.810 0.507 1.293 0.3774 ACEI/ARB 0.916 0.648 1.296 0.6216 OR: odds ratio; CI: confidence interval; BMI, body mass index; SUA, serum uric acid; LVEF, left ventricular ejection fraction; CVA, cerebrovascular accident; STEMI, ST elevated myocardial infarction; NSTEMI, non-ST elevated myocardial infarction; BMS, bare-metal stent; DES, drug-eluting stent; ACS, acute coronary syndrome; DAPT, dual antiplatelet therapy; and ACEI/ARB, angiotensin converting enzyme inhibitor/angiotensin II receptor blocker. * Stepwise backward model for the factors: age, SUA ≥ 7.25 mg/dL, LVEF, hypertension, diabetes mellitus, chronic kidney insufficiency, uremia, heart failure, atrial fibrillation, BMS, DES and number of diseased vessels. Table 4. The univariable and multivariable COX regression models predict MACE, TVR/TLR, re-MI, and all ACM. Univariable model Multiple model* HR 95% CI p -value HR 95% CI p -value MACE 1.489 1.090 2.033 0.0123 1.399 1.024 1.912 0.0350 TVR/TLR 1.036 0.684 1.569 0.8684 0.976 0.644 1.480 0.9101 re-MI 3.935 1.683 9.203 0.0016 3.758 1.605 8.799 0.0023 A CM 2.049 1.074 3.907 0.0294 1.956 1.019 3.753 0.0438 MACE, major adverse cardiovascular event; TVR, target vessel revascularization; TLR, target lesion revascularization; MI, myocardial infarction; ACM, all-cause mortality; SUA, serum uric acid; and DES, drug-eluting stent. SUA <7.25 ng/mL served as the reference. * Adjusted for age, uremia, DES, and number of diseased vessels. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7514499","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":516143676,"identity":"1af9c481-8372-48b3-ad47-2ff677dbc171","order_by":0,"name":"Cheng-Hung Chiang","email":"","orcid":"","institution":"Kaohsiung Veterans General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Cheng-Hung","middleName":"","lastName":"Chiang","suffix":""},{"id":516143679,"identity":"39e02d4b-db19-43ea-8f37-bc96f0652113","order_by":1,"name":"Mei-Chi Wang","email":"","orcid":"","institution":"Kaohsiung Veterans General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mei-Chi","middleName":"","lastName":"Wang","suffix":""},{"id":516143680,"identity":"e122fccd-6534-4e27-b0bc-045c2fc992c2","order_by":2,"name":"En-Shao Liu","email":"","orcid":"","institution":"Kaohsiung Veterans General Hospital","correspondingAuthor":false,"prefix":"","firstName":"En-Shao","middleName":"","lastName":"Liu","suffix":""},{"id":516143682,"identity":"4211ac9c-233b-4894-9e97-6dcaef2e82af","order_by":3,"name":"Tse-Hsuan Yang","email":"","orcid":"","institution":"Kaohsiung Veterans General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Tse-Hsuan","middleName":"","lastName":"Yang","suffix":""},{"id":516143684,"identity":"e186daed-bac1-419b-9733-9e76c7b0ec15","order_by":4,"name":"Haw-Ting Tai","email":"","orcid":"","institution":"Kaohsiung Veterans General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Haw-Ting","middleName":"","lastName":"Tai","suffix":""},{"id":516143685,"identity":"4dbfbeba-5e9e-4b5e-9996-c8dac910ab95","order_by":5,"name":"Jeng-Fung Hung","email":"","orcid":"","institution":"National Kaohsiung Normal University","correspondingAuthor":false,"prefix":"","firstName":"Jeng-Fung","middleName":"","lastName":"Hung","suffix":""},{"id":516143686,"identity":"b79b29cc-b61a-46ee-9b2b-1a5dcf7d75b6","order_by":6,"name":"Feng-Yu Kuo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIiWNgGAWjYBAC9gYIbcDAwHwASEvIENTCcwCuhS0BpIWHFC08BmABwlrYew+/5qk4bGxwvOfzqxs1FjwM7IePbsCrhedcmjXPmcNmBmfObrPOOQZ0GE9a2g18WuwlcsyMedsO2xjcyN1mnMMG1CLBY4ZXC4/8G5iWnGfGOf+I0SLBY/wYqMUMqIX5cW4bMVp4cswY55xJN5Y8c8yMObdPgoeNkF942M8Yf3hTYW3Yd7z58eecb3Vy/OyHj+HVAgRsUtC4YJMAkwSUgwDzxx9QxgciVI+CUTAKRsEIBACXD0Xixz4qRQAAAABJRU5ErkJggg==","orcid":"","institution":"Kaohsiung Veterans General Hospital","correspondingAuthor":true,"prefix":"","firstName":"Feng-Yu","middleName":"","lastName":"Kuo","suffix":""}],"badges":[],"createdAt":"2025-09-02 07:23:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7514499/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7514499/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12872-025-05322-2","type":"published","date":"2025-11-25T15:58:05+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":91560763,"identity":"888d2daa-8049-4ee6-8f52-2e956de2045f","added_by":"auto","created_at":"2025-09-17 18:44:39","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":71256,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart of the study. ACS, acute coronary syndrome; DOAC, direct oral anticoagulant; BMI, body mass index; SUA, serum uric acid; HbA1c, glycated hemoglobin; eGFR, estimated glomerular filtration rate; TG, triglyceride; HDL, high density lipoprotein; LDL, low density lipoprotein; CK, creatine kinase; CK-MB, creatine kinase MB; LVEF, left ventricular ejection fraction; CVA, cerebrovascular accident; STEMI, ST elevated myocardial infarction; NSTEMI, non-ST elevated myocardial infarction; CAD, coronary artery disease; BMS, bare-metal stent; DES, drug-eluting stent; ACEI/ARB, angiotensin converting enzyme inhibitor/angiotensin II receptor blocker; and ROC, receiver operating characteristic.\u003c/p\u003e","description":"","filename":"20250806Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-7514499/v1/4127c5a4943e786d84f4f015.png"},{"id":91560764,"identity":"6c419741-78a2-43a3-a4a2-bf326ae26afa","added_by":"auto","created_at":"2025-09-17 18:44:39","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":44301,"visible":true,"origin":"","legend":"\u003cp\u003eROC curve for the cuff-off value of serum uric acid levels to predict MACE rate. ROC, receiver operating characteristic; and MACE, major adverse cardiovascular event.\u003c/p\u003e","description":"","filename":"20250803Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-7514499/v1/414c0cd145e7271fb2a1e3e9.png"},{"id":91562181,"identity":"3c31e7a6-0f54-4601-a14d-6f0d08ac0943","added_by":"auto","created_at":"2025-09-17 18:52:39","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1807813,"visible":true,"origin":"","legend":"\u003cp\u003eLong term event free survival rates between low and normal serum uric acid groups by Kaplan-Meier survival curve: (a) MACE (b) TVR/TLR (c) re-MI (d) ACM. MACE, major adverse cardiovascular event; TVR, target vessel revascularization; TLR, target lesion revascularization; MI, myocardial infarction; and ACM, all-cause mortality\u003c/p\u003e","description":"","filename":"20250803Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-7514499/v1/749cba18e29c1c83d2a21268.png"},{"id":97179372,"identity":"e7d9072d-de89-402b-96a7-d48548d4c81a","added_by":"auto","created_at":"2025-12-01 16:15:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3056531,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7514499/v1/836cd0a8-b7bd-410d-a11d-73c98857b8bc.pdf"},{"id":91563792,"identity":"aa3f7f5a-80ad-4703-a998-9ac4727c6ef4","added_by":"auto","created_at":"2025-09-17 19:08:39","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":36228,"visible":true,"origin":"","legend":"","description":"","filename":"20250805SupplementaryTable.docx","url":"https://assets-eu.researchsquare.com/files/rs-7514499/v1/a97c797929fdd3183390904e.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Influence of Serum Uric Acid on Risks of Major Adverse Cardiovascular Events in Patients with Acute Coronary Syndrome","fulltext":[{"header":"Background","content":"\u003cp\u003eAcute coronary syndrome (ACS), which is one of the leading causes of death and disability worldwide, has become a global health care burden.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] In patients with ACS, identifying biomarkers that can predict future cardiovascular risk is crucial for improving clinical outcomes and guiding therapeutic interventions. Serum uric acid (SUA) has gained attention as one such biomarker, with a growing body of evidence suggesting that elevated SUA levels may be associated with adverse cardiovascular outcomes, including major adverse cardiovascular events (MACE), myocardial infarction (MI), and mortality.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eRecurrent MI (re-MI) is one of the most common adverse cardiovascular events that may occur after an episode of ACS. According to the fourth universal definition of myocardial infarction, re-MI refers to MI that occurs beyond 28 days following the index MI event.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] Due to its frequent occurrence and prognostic implications, re-MI is routinely included in the composite outcome of MACE among studies targeting patients with ACS. Therefore, re-MI and other MACE tend to share many common risk factors.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] A recent study revealed a rate of re-MI within one year after the initial MI of up to 2.5% together with a high mortality rate of 53.3%.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] Studies about re-MI rate and MACE with longer follow-up after ACS was relative scarce.\u003c/p\u003e\u003cp\u003eUric acid, the end-product of purine metabolism, has been implicated in various pathological processes linked to cardiovascular disease. Previous studies have shown that elevated SUA is associated with endothelial dysfunction, oxidative stress, and chronic inflammation, all of which are key mechanisms underlying the pathogenesis of atherosclerosis and coronary artery disease.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] Hyperuricemia has also been found to increase the risk of hypertension, chronic kidney disease (CKD), and metabolic syndrome, further compounding its potential as a cardiovascular risk factor.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eDespite the known associations, the clinical significance of SUA in ACS patients remains a topic of ongoing research. Some studies suggest that elevated SUA is an independent predictor of adverse cardiovascular events, while others argue that it is merely a marker of other risk factors such as chronic kidney disease and metabolic dysfunction.[\u003cspan additionalcitationids=\"CR12 CR13 CR14\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] Recent studies have also examined the role of SUA as a prognostic factor in various cardiovascular contexts, further suggesting its clinical relevance in risk assessment.[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] Although numerous investigations have linked hyperuricemia to short-term mortality and MACE after ACS, most published cohorts were Western, had follow-up limited to \u0026le;\u0026thinsp;12 months, and treated re-MI only as part of a composite endpoint. To our knowledge, no East-Asian study has examined long-term (up to 5 years) outcomes while separating re-MI from the broader MACE construct. Moreover, existing reports usually apply arbitrary sex-based uric-acid thresholds; few have derived an optimal cut-off directly from their own data.\u003c/p\u003e\u003cp\u003eAccordingly, the present study (i) follows a large Taiwanese ACS cohort for as long as 60 months, (ii) evaluates re-MI as an independent endpoint alongside traditional MACE components, and (iii) employs a receiver-operating-characteristic (ROC) approach to generate a population-specific cut-off for high SUA. These features allow us to re-examine the prognostic role of SUA in a contemporary East-Asian setting and to provide clinicians with a data-driven threshold that may be more applicable than historical reference values.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStudy design and setting\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present retrospective cohort study focused on inpatients diagnosed with ACS at a single tertiary referral hospital between January 1, 2015 and December31, 2019.\u0026nbsp;All follow up was passive and based on retrospective review of our hospital\u0026rsquo;s medical records; no telephone calls, clinic visits scheduled for research, or external registry linkages were used.\u0026nbsp;After discharge, patients were given routine cardiology appointments at 1 week, 1 month, and every 3 months thereafter, with earlier visits if new symptoms occurred. At each visit the cardiologist recorded clinical status and any interim cardiovascular events; any readmissions were captured in the same\u0026nbsp;medical records.\u0026nbsp;The length of observation for each patient\u0026mdash;from discharge to the last documented clinic visit or readmission\u0026mdash;was extracted from the medical record.\u0026nbsp;Of the\u0026nbsp;1,949 patients admitted for ACS\u0026nbsp;during\u0026nbsp;the study period,\u0026nbsp;174 expired during index hospitalization and 899 were excluded because of incomplete SUA data, 42 with the use of oral anticoagulants or warfarin were deemed ineligible and excluded to avoid confounding,\u0026nbsp;as these individuals often had comorbid conditions (such as atrial fibrillation or mechanical heart valves) affecting outcomes, and 5 were omitted as a consequence of loss to follow-up. Finally, 829 patients\u0026nbsp;were\u0026nbsp;enrolled in this study. (\u003cstrong\u003eFigure 1\u003c/strong\u003e)\u0026nbsp;The protocol and procedures of the current study were reviewed and approved by the institutional review board (IRB) of our institute (No. VGHKS20-CT7-22).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStudy parameters\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBaseline characteristics [i.e., age, body-mass index (BMI), sex, and\u0026nbsp;comorbidities], clinical and\u0026nbsp;laboratory\u0026nbsp;data\u0026nbsp;on\u0026nbsp;admission [i.e.,\u0026nbsp;left-ventricular ejection fraction (LVEF), SUA,\u0026nbsp;glycated hemoglobin (HbA1c), estimated glomerular filtration rate (eGFR), total cholesterol, including high-density lipoprotein (HDL) and low-density lipoprotein (LDL), triglyceride, and peak values of creatine kinase (CK), creatine kinase MB (CK-MB), and high-sensitivity Troponin I], types of ACS [ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina], number of diseased vessels, type of coronary artery disease(CAD) [single vessel disease (SVD), double vessel disease (DVD), or triple vessel disease (TVD)], implanted stents [bare-metal stent (BMS) or drug-eluting stent (DES)] and discharge medications after ACS [i.e.,\u0026nbsp;anti-platelets, beta blockers, statins, angiotensin II receptor blockers (ARBs) or angiotensin-converting enzyme inhibitors (ACEIs)],\u0026nbsp;and\u0026nbsp;data on\u0026nbsp;hospital re-admission were retrospectively collected from the patients\u0026rsquo; medical records. SUA was not part of standard ACS admission panel during the study years. Whether SUA was measured depended on the attending cardiologist.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDefinitions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMACE was defined as the composite outcome of all-cause mortality (ACM), re-MI, and target lesion revascularization/target vessel revascularization (TLR/TVR) up to 60-month follow-up after\u0026nbsp;percutaneous coronary intervention\u0026nbsp;(PCI). Receiver operating characteristic (ROC) curve and area under curve (AUC) were used to determine the correlation between serum uric acid concentration and the risk of MACE. The optimal cutoff SUA level was 7.25 mg/dL, which yielded a sensitivity of 43.9% and specificity of 70.4% for predicting 60-month MACE in our cohort. (\u003cstrong\u003eFigure 2\u003c/strong\u003e) The eligible patients were further divided into normal SUA group (defined as SUA level \u0026lt;7.25 ng/mL) and high SUA group (defined as\u0026nbsp;SUA level\u0026nbsp;\u0026ge;7.25\u0026nbsp;ng/mL).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStatistical Analyses\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eContinuous variables and categorical variables are shown as mean \u0026plusmn; standard deviation and number with percentage (n, %), respectively. Independent sample t tests and Chi-squared tests were performed to determine the significance of difference in patient characteristics, laboratory findings, medications, and the incidence of re-admission between the normal and high SUA groups. Kaplan-Meier survival analysis was conducted to compare the survival probability of MACE between the two groups. To identify significant risk factors, we used logistic regression to assess the association between patient characteristics and MACE expressed as odds ratio (OR) and 95% confidence interval (CI). Furthermore, we evaluated the hazard ratio (HR) and 95% CI between the patients\u0026rsquo; SUA level and their MACE outcomes with Cox proportional hazards regression, which can be used for survival-time (time-to-event) outcomes on one or more predictors. A \u003cem\u003ep\u003c/em\u003e value of less than 0.05 was considered statistically significant. All statistical analyses were conducted with the software IBM SPSS 22.0 and SAS 9.4.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOf the 829 eligible patients, 566 were assigned to the normal SUA group (i.e., SUA level \u0026lt;7.25 ng/mL) and 263 fit the recruitment criterion for the high SUA group (i.e., SUA \u0026ge;7.25 ng/mL). The flowchart of enrollment is presented in \u003cstrong\u003eFigure 1\u003c/strong\u003e. Median follow-up for the whole cohort was 12.0 months [inter-quartile range (IQR) 4.41\u0026ndash;27.09; 365 days (IQR 134\u0026ndash;824)]. In the normal-UA group the median was 11.18 months [IQR 4.37\u0026ndash;24.66; 340 days (133\u0026ndash;750)], whereas the high-UA group was followed slightly longer, 13.91 months [IQR 4.53\u0026ndash;29.56; 423 days (138\u0026ndash;899)]. Approximately one quarter of patients contributed follow-up beyond 27 months and 121 patients over 3 years. The baseline characteristics of all participants are listed in\u003cstrong\u003e\u0026nbsp;Table 1\u003c/strong\u003e. The proportion of male patients in the high SUA group was higher than that in the normal SUA group (88.59% vs. 83.32%, \u003cem\u003ep\u003c/em\u003e=0.0440), while the latter had lower SUA (5.50 \u0026plusmn; 1.12 vs. 8.82 \u0026plusmn; 1.48,\u0026nbsp;\u003cem\u003ep\u003c/em\u003e\u0026lt;0.0001), higher eGFR (68.10 \u0026plusmn; 25.01 vs. 51.00 \u0026plusmn; 25.76,\u0026nbsp;\u003cem\u003ep\u003c/em\u003e\u0026lt;0.0001), HDL concentration (40.09 \u0026plusmn; 9.80 vs. 37.86 \u0026plusmn; 9.49,\u0026nbsp;\u003cem\u003ep\u003c/em\u003e=0.0033)\u0026nbsp;and LVEF (51.72\u0026plusmn;7.99 vs.\u0026nbsp;48.49\u0026plusmn;9.38, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.0001) compared with the former.\u0026nbsp;Regarding comorbidities, patients in\u0026nbsp;the\u0026nbsp;normal SUA group showed\u0026nbsp;a\u0026nbsp;lower\u0026nbsp;prevalence\u0026nbsp;of hypertension (43.82% vs. 56.27%,\u0026nbsp;\u003cem\u003ep\u003c/em\u003e=0.0008), diabetes mellitus (33.57% vs. 41.83%,\u0026nbsp;\u003cem\u003ep\u003c/em\u003e=0.0213), CKD (5.30% vs. 20.15%, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.0001), heart failure (10.78% vs. 16.35%,\u0026nbsp;\u003cem\u003ep\u003c/em\u003e=0.0242), and gout (7.60% vs. 18.63%, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.0001) than\u0026nbsp;those\u0026nbsp;in the high SUA group. Focusing on the type of ACS, patients in the normal SUA group exhibited more STEMI (54.95% vs. 43.35%), less NSTEMI (43.64% vs. 53.99%) and unstable angina (1.41% vs. 2.66%) compared with their high SUA counterparts (\u003cem\u003ep\u0026nbsp;\u003c/em\u003e= 0.0056).\u0026nbsp;In respect of\u0026nbsp;medications, patients in\u0026nbsp;the\u0026nbsp;normal SUA group had higher rates of receiving P2Y12 (98.23% vs. 95.82%, \u003cem\u003ep\u003c/em\u003e=0.0394) and dual-antiplatelet therapy (93.64% vs. 92.02%,\u0026nbsp;\u003cem\u003ep\u003c/em\u003e=0.0496) than\u0026nbsp;those\u0026nbsp;in\u0026nbsp;the\u0026nbsp;high SUA group.\u003c/p\u003e\n\u003cp\u003eThe cardiovascular events of the two groups are summarized in \u003cstrong\u003eTable 2\u003c/strong\u003e. The\u0026nbsp;overall MACE rate of all the patients was 19.54%. It was lower in the normal SUA group than that in the high SUA group (16.25% vs. 26.62%, respectively, \u003cem\u003ep\u003c/em\u003e=0.0005). Regarding the need for revascularization, the overall TLR/TVR rate was 11.94% without significant differences between the two groups (11.48% vs. 12.93%, \u003cem\u003ep\u003c/em\u003e=0.5508). In addition, the re-MI rate was lower in the normal SUA group than that in the high SUA group (1.41% vs. 6.08%, respectively, \u003cem\u003ep\u003c/em\u003e=0.0002), giving an overall rate of 2.90%. The ACM rate of the participants in the normal SUA group was lower than that in those with high SUA (3.18% vs. 7.22%, \u003cem\u003ep\u003c/em\u003e=0.0087), with the overall rate being 4.46%.\u003c/p\u003e\n\u003cp\u003eKaplan-Meier event-free survival analysis of MACE, TLR/TVR, re-MI, and ACM up to 60 months of follow-up is shown in \u003cstrong\u003eFigure 3\u003c/strong\u003e. Compared with the high SUA group, the MACE, re-MI, and ACM rates were all significantly lower in the normal SUA group with log-rank\u0026nbsp;\u003cem\u003ep\u003c/em\u003e values of 0.0117, 0.0006, and 0.0261, respectively. On the other hand, no significant difference was noted in the TLR/TVR rate between the two groups (log-rank \u003cem\u003ep\u003c/em\u003e value of 0.8691).\u003c/p\u003e\n\u003cp\u003eThe association between patients\u0026rsquo; characteristics and MACE by univariable and multivariable logistic regression is demonstrated in \u003cstrong\u003eTable 3\u003c/strong\u003e. Univariable logistic regression analysis revealed a correlation between an increased MACE rate with age (OR: 1.025, 95% CI 1.012 to 1.038,\u0026nbsp;\u003cem\u003ep\u003c/em\u003e\u0026lt;0.0001), SUA \u0026ge; 7.25\u0026nbsp;ng/mL (OR: 1.869, 95% CI 1.313 to 2.660,\u0026nbsp;\u003cem\u003ep\u003c/em\u003e=0.0005), SUA (OR:\u0026nbsp;1.159, 95% CI 1.066 to 1.259, \u003cem\u003ep\u003c/em\u003e=0.0005), the presence of hypertension (OR: 1.837, 95% CI 1.295 to 2.604,\u0026nbsp;\u003cem\u003ep\u003c/em\u003e=0.0006), diabetes mellitus (OR: 1.694, 95% CI 1.196 to 2.399,\u0026nbsp;\u003cem\u003ep\u003c/em\u003e=0.0030), CKD (OR: 2.475, 95% CI 1.518 to 4.035,\u0026nbsp;\u003cem\u003ep\u003c/em\u003e=0.0003), uremia (OR: 4.607, 95% CI 2.482 to 8.552, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.0001), heart failure (OR: 2.147, 95% CI 1.363 to 3.384, \u003cem\u003ep\u003c/em\u003e=0.0010), atrial fibrillation (OR: 2.526, 95% CI 1.468 to 4.347, \u003cem\u003ep\u003c/em\u003e=0.0008), number of diseased vessels (OR: 1.748, 95% CI 1.405 to 2.174, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.0001) and the use of BMS (OR: 1.720, 95% CI 1.206 to 2.451, \u003cem\u003ep\u003c/em\u003e=0.0027). On the other hand, LVEF (OR: 0,974, 95% CI 0.953 to 0,996, \u003cem\u003ep\u003c/em\u003e=0.0211) and the use of DES (OR: 0.508, 95% CI 0.359 to 0.719, \u003cem\u003ep\u003c/em\u003e=0.0001) were associated with a lower MACE rate. The backward stepwise multiple logistic regression models to predict MACE were performed and factors such as age, SUA (\u0026ge;7.25 mg/dL), LVEF, hypertension, diabetes mellitus, chronic kidney insufficiency, uremia, heart failure, atrial fibrillation, BMS, DES and number of diseased vessels were selected. (\u003cstrong\u003eSupplementary Table\u003c/strong\u003e) Multivariable logistic regression\u0026nbsp;analysis identified\u0026nbsp;age (OR: 1.019, 95% CI 1.005 to 1.034,\u0026nbsp;\u003cem\u003ep\u003c/em\u003e=0.0087), SUA \u0026ge;7.25 ng/mL (OR: 1.639, 95% CI 1.084 to 2.477,\u0026nbsp;\u003cem\u003ep\u003c/em\u003e=0.0191), uremia (OR: 2.692, 95% CI 1.245 to 5.802, \u003cem\u003ep\u003c/em\u003e=0.0118), number of diseased vessels(OR: 1.716, 95% CI 1.334 to 2.208,\u0026nbsp;\u003cem\u003ep\u003c/em\u003e\u0026lt;0.0001)\u0026nbsp;as significant predictors of\u0026nbsp;increased MACE rates and the use of DES (OR: 0.591, 95% CI 0.394 to 0.888, \u003cem\u003ep\u003c/em\u003e=0.0114) significantly decrease MACE rate.\u003c/p\u003e\n\u003cp\u003eThe HRs by COX regression models to predict CV events based on SUA are summarized in \u003cstrong\u003eTable 4\u003c/strong\u003e. Before adjustment with patients having a SUA concentration \u0026lt;7.25 ng/mL that served as the reference group, the rates of MACE (HR: 1.489, 95% CI 1.090 to 2.033,\u0026nbsp;\u003cem\u003ep\u003c/em\u003e=0.0123), re-MI (HR: 3.935, 95% CI 1.683 to 9.203,\u0026nbsp;\u003cem\u003ep\u003c/em\u003e=0.0016), and ACM (HR: 2.049, 95% CI 1.074 to 3.907,\u0026nbsp;\u003cem\u003ep\u003c/em\u003e=0.0294) were higher in patients with an elevated SUA level than those with a normal SUA concentration. After\u0026nbsp;adjusting for\u0026nbsp;age, uremia, DES, and number of diseased vessels, as well as\u0026nbsp;patients\u0026nbsp;with normal SUA\u0026nbsp;concentrations serving as\u0026nbsp;the\u0026nbsp;reference group, the rates of MACE (HR: 1.399, 95% CI 1.024 to 1.912, \u003cem\u003ep\u003c/em\u003e=0.0350), re-MI (HR: 3.758, 95% CI 1.605 to 8.799, \u003cem\u003ep\u003c/em\u003e=0.0023) and ACM (HR: 1.956, 95% CI 1.019 to 3.753, \u003cem\u003ep\u003c/em\u003e=0.0438) were significantly higher in the high SUA group than that in the normal SUA group.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this retrospective single-center cohort, we found that patients admitted with ACS who had high SUA were more likely to develop adverse events, even after full adjustment for clinical and procedural factors. Our study stands out because we followed an East-Asian population for up to five years, treated re-MI as a separate outcome and showed it was more than three times as common in the high SUA group, and determined a data-driven cut-off value of 7.25 mg/dL rather than relying on traditional laboratory thresholds. Together, these results confirm the prognostic importance of SUA and offer a practical, locally derived threshold that may help clinicians identify higher-risk ACS patients. Our findings are consistent with those of previous studies that explored the prognostic value of SUA in cardiovascular disease. For instance, a prior meta-analysis showed an increased risk of MACE (RR: 1.86; 95% CI: 1.47\u0026ndash;2.35), and ACM (RR 1.86; 95% CI: 1.49\u0026ndash;2.32) in ACS patients with concomitant hyperuricemia after adjustment for the conventional risk factors.[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] Another meta-analysis reported an elevated incidence of short-term (RR\u0026thinsp;=\u0026thinsp;1.46, 95% CI: 1.40\u0026ndash;1.51) and long-term (RR\u0026thinsp;=\u0026thinsp;1.43, 95% CI: 1.35\u0026ndash;1.52) MACE as well as re-MI (RR\u0026thinsp;=\u0026thinsp;1.49, 95% CI: 1.06\u0026ndash;2.10) in patients diagnosed with MI and elevated SUA levels.[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] In concert with these findings, a prior study further revealed a positive correlation between SUA concentration and six-month fatal reinfarction in individuals with elevated UA levels compared with those with normal UA concentrations (9.8% vs. 2.7%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002), ACM (19.6 vs. 4.1, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and MACE (26.6% vs. 11%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eRe-MI, which is not uncommon following ACS, contributed to a significant increase in risks of subsequent cardiovascular events and mortality.[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] Due to its frequent occurrence and prognostic implications, re-MI is routinely included as a component of the composite outcome of MACE in studies focusing on patients with ACS.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] Conceivably, re-MI and other MACE are known to share a number of common risk factors, including age, female sex, prior MI, prior stroke, diabetes, left ventricular dysfunction, failed or not attempted revascularization, high Killip class, low systolic blood pressure, and renal failure.[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] Previous studies have investigated the usefulness of biomarkers in the predication of re-MI. While one study reported the absence of specific biomarker in this setting [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], a meta-analysis identified C-reactive protein (CRP) as a predictor of re-MI (OR: 1.76, 95% CI: [1.28, 2.43], \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) in patients with AMI undergoing PCI.[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] In addition, another study demonstrated the reliability of high-sensitivity troponins (hs-cTnT and hs-cTnI) as biomarkers of recurrent cardiovascular events.[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] Focusing on SUA, our data revealed significantly higher rates of re-MI (HR: 3.758, 95% CI 1.605 to 8.799, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0023) in ACS patients with elevated SUA levels compared to those with normal SUA concentrations after adjusting for age, uremia, DES, and number of diseased vessels. Consistently, a previous clinical study recruiting 1215 patients reported a 1.5-fold increased risk of MI (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.032) among patients with hyperuricemia compared to those without over a mean follow-up period of 5.5 years.[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] The results of our study suggested that a high SUA concentration could be a significant prognostic factor for re-MI and MACE after up to five years of follow-up. Unlike the earlier study using fixed UA thresholds (i.e., \u0026ge;\u0026thinsp;7.0 mg/dL for men and \u0026ge;\u0026thinsp;6.0 mg/dL for women), the current study employed a data-driven approach by utilizing a ROC curve to determine a cutoff value (\u0026ge;\u0026thinsp;7.25 mg/dL) to enhance the precision of our findings and improve their applicability to our specific patient population. Besides, our study further included re-MI as a distinct endpoint in an attempt to shed light on the association of SUA on the risk of ACS-related adverse cardiovascular outcomes, particularly re-MI.\u003c/p\u003e\u003cp\u003eHyperuricemia has been linked to increased oxidative stress, impaired endothelial function, and activation of the renin-angiotensin system, which can exacerbate the progression of atherosclerosis.[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] Moreover, provided that chronic kidney disease is a well-known independent risk factor for cardiovascular events, hyperuricemia may increase cardiovascular risk through impairing kidney function.[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] Additionally, the association of hyperuricemia with other metabolic abnormalities, such as insulin resistance and metabolic syndrome, further highlights its importance as a marker of cardiovascular risk.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] Other possible mechanisms that may be associated with uric acid-related increase in risk of adverse cardiovascular outcomes also include inflammation induction and endothelial damage as demonstrated in previous studies that investigated the long-term cardiovascular outcomes of patients following ACS. [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eDue to a lack of consensus on the cardiovascular cutoff value for hyperuricemia, the definition varied in different studies. While two studies used SUA\u0026thinsp;\u0026gt;\u0026thinsp;7 mg/dL in males and \u0026gt;\u0026thinsp;6 mg/dL in females as cutoff values,[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] one study adopted SUA\u0026thinsp;\u0026gt;\u0026thinsp;8 mg/dL in men and \u0026gt;\u0026thinsp;7.5 mg/dL in women.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] Other studies used either \u0026gt;\u0026thinsp;6.2 mg/dL, \u0026gt;\u0026thinsp;6.5 mg/dl, or \u0026ge;\u0026thinsp;6.8 mg/dL as cutoff values.[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan additionalcitationids=\"CR36\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] The cutoff value for hyperuricemia in the current study was SUA\u0026thinsp;\u0026ge;\u0026thinsp;7.25 mg/dL according to the ROC curve for MACE prediction in our study population (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The slight differences between studies likely reflect population differences (ACS severity, comorbidities) and endpoints considered. Our cutoff is in line with the general range identified in literature, which reinforces its clinical plausibility. At the same time, our findings echo the point made in a recent review: different studies have found dissimilar UA cut-offs for cardiovascular risk, and none have been universally validated.[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] This suggests that while hyperuricemia is undoubtedly a risk marker, the exact threshold for high risk may need tailoring to specific patient groups.\u003c/p\u003e\u003cp\u003eOur study found no significant difference in the TLR/TVR rates between the normal and high SUA groups (11.48% vs. 12.93%, respectively, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.5508). Previous studies reported inconsistent results regarding the association of SUA on the risk of coronary arterial restenosis after PCI. A prior clinical investigation analyzing the association of hyperuricemia on the long-term risk of in-stent restenosis (ISR) among patients after PCI showed similar degree of late lumen loss (0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9 mm vs. 0.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1 mm, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.895) and rate of binary restenosis (28.1% vs. 34.7%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.622) between patients with and without hyperuricemia.[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e] In contrast, another study proposed that elevated preprocedural SUA could be a powerful and independent predictor of BMS restenosis in patients with stable and unstable angina pectoris (23% in the lowest tertile, 34% in the middle tertile, and 46% in the highest tertile, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e] Likewise, a clinical study assessing the association between the uric acid to albumin ratio (UAR) and the incidence of ISR concluded that UAR was positively associated with the risk of ISR in patients with CAD undergoing PCI with DES implantation.[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] Pathophysiologically, ISR is considered to be the result of natural inflammatory responses after stent implantation. Accordingly, previous studies have shown a positive association of high-sensitivity C-reactive protein (hsCRP) and other inflammatory biomarkers with ISR and poor clinical outcomes after DES implantation.[\u003cspan additionalcitationids=\"CR43 CR44\" citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e] Being the first investigation into the association of SUA on the risk of long-term TLR/TVR in patients diagnosed with ACS, the current study showed no significant difference between participants with hyperuricemia and those without. Other well-known risks factors, such as the type, size, and number of stent being implanted, complexity of coronary arterial lesions, and serum lipid profile, as well as the presence of diabetes mellitus and chronic kidney disease, may have a more significant association on long-term TLR/TVR than SUA in patients having experienced ACS.[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e] Nevertheless, our findings suggested that routine assessment of SUA levels in patients diagnosed with ACS could aid in identifying those at risk of adverse cardiovascular outcomes, thereby allowing for timely and targeted therapeutic interventions.\u003c/p\u003e\n\u003ch3\u003eStrengths and Limitations\u003c/h3\u003e\n\u003cp\u003eThis study had several strengths. First, it was based on a relatively large cohort of patients with ACS, thereby enabling a robust analysis of the association between SUA levels and cardiovascular outcomes. Second, the use of multivariate analysis adjusted for known cardiovascular risk factors such as age, kidney function, and atrial fibrillation strengthens the validity of our findings by minimizing potential confounding effects. Third, a follow-up of up to 60 months allowed the gaining of valuable insights into the long-term prognostic value of SUA, thereby providing real-world information for improving the clinical care of patients having experienced ACS.\u003c/p\u003e\u003cp\u003eHowever, this study also had its limitations. First, this was a retrospective study from a single center; while the uniform treatment protocols and complete electronic records enhance internal consistency, the findings may not be generalizable to other settings. Future multi-center, prospective studies are needed to confirm these results. Second, the retrospective nature of the study rendered it susceptible to selection bias and potential confounders that were not measured or controlled for. Third, while we adjusted several key variables, there could be residual confounding effects from unmeasured factors such as diet, physical activity, and genetic predispositions, which could influence both SUA levels and cardiovascular outcomes. Fourth, there was a lack of information on pharmacological interventions that may affect SUA levels (e.g., urate-lowering therapies) and alter the risk of cardiovascular events. Fifth, because SUA testing was left to each physician\u0026rsquo;s discretion and was not routine, almost half of the original ACS admissions lacked SUA value and had to be excluded. This discretionary ordering may introduce selection bias.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe findings of our study add to the growing body of evidence that supports a positive association between hyperuricemia and an increased risk of MACE, re-MI and ACM events in patients with ACS, suggesting the potential benefit of routine SUA assessment in the identification of patients experiencing ACS at risk of adverse cardiovascular outcomes to tailor individualized treatment strategies.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eACS, acute coronary syndrome; ACM, all-cause mortality; AUC, area under the curve; BMI, body mass index; BMS, bare-metal stent; CAD, coronary artery disease; CI, confidence interval; CK, creatine kinase; CK-MB, Creatine kinase MB; CKD, chronic kidney disease; CRP, C-reactive protein; DES, drug-eluting stent; eGFR, estimated glomerular filtration rate; HbA1c, glycated hemoglobin; HDL, high-density lipoprotein; HR, hazard ratio; hs-CRP, high-sensitivity C-reactive protein; hs-cTnI, high-sensitivity troponin I; hs-cTnT, high-sensitivity troponin T; IQR, interquartile range; ISR, in-stent restenosis; LVEF, left ventricular ejection fraction; MACE, major adverse cardiovascular events; MI, myocardial infarction; NSTEMI, non\u0026ndash;ST elevation myocardial infarction; OR, odds ratio; PCI, percutaneous coronary intervention; ROC, receiver operating characteristic; STEMI, ST elevation myocardial infarction; SUA, serum uric acid; TLR, target lesion revascularization; TVR, target vessel revascularization; and UAR, uric acid to albumin ratio.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eT\u003c/strong\u003ehis study was approved by the Institutional Review Board of Kaohsiung Veterans General Hospital, Taiwan (Approval No. VGHKS20-CT7-22). As this was a retrospective study using anonymized data, the requirement for informed consent was waived by the ethics committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCHC conceived the study, collected and analyzed the data, and drafted the manuscript. MCW performed statistical analyses. ESL, TSY, HTT, and JFH contributed to data collection, interpretation, and critical revision of the manuscript. FYK supervised the study and revised the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eG.A. Roth, G.A. Mensah, C.O. Johnson, G. Addolorato, E. Ammirati, L.M. Baddour, N.C. Barengo, A.Z. Beaton, E.J. Benjamin, C.P. Benziger, A. Bonny, M. Brauer, M. Brodmann, T.J. Cahill, J. Carapetis, A.L. Catapano, S.S. Chugh, L.T. Cooper, J. Coresh, M. Criqui, N. DeCleene, K.A. Eagle, S. Emmons-Bell, V.L. Feigin, J. Fern\u0026aacute;ndez-Sol\u0026agrave;, G. Fowkes, E. Gakidou, S.M. Grundy, F.J. He, G. Howard, F. Hu, L. Inker, G. Karthikeyan, N. Kassebaum, W. Koroshetz, C. Lavie, D. Lloyd-Jones, H.S. Lu, A. Mirijello, A.M. Temesgen, A. 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Zeng, Evaluation of C-reactive protein as predictor of adverse prognosis in acute myocardial infarction after percutaneous coronary intervention: A systematic review and meta-analysis from 18,715 individuals, Frontiers in Cardiovascular Medicine 9 (2022).\u003c/li\u003e\n\u003cli\u003eH. Jansen, A. J\u0026auml;nsch, L.P. Breitling, L. Hoppe, D. Dallmeier, R. Schmucker, H. Brenner, W. Koenig, D. Rothenbacher, Hs-cTroponins for the prediction of recurrent cardiovascular events in patients with established CHD - A comparative analysis from the KAROLA study, Int J Cardiol 250 (2018) 247-252.\u003c/li\u003e\n\u003cli\u003eM. Tscharre, R. Herman, M. Rohla, C. Hauser, S. Farhan, M.K. Freynhofer, K. Huber, T.W. Weiss, Uric acid is associated with long-term adverse cardiovascular outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention, Atherosclerosis 270 (2018) 173-179.\u003c/li\u003e\n\u003cli\u003eM.A. Yu, L.G. S\u0026aacute;nchez-Lozada, R.J. Johnson, D.H. Kang, Oxidative stress with an activation of the renin-angiotensin system in human vascular endothelial cells as a novel mechanism of uric acid-induced endothelial dysfunction, J Hypertens 28(6) (2010) 1234-42.\u003c/li\u003e\n\u003cli\u003eM. Kanbay, M. Segal, B. Afsar, D.H. Kang, B. Rodriguez-Iturbe, R.J. Johnson, The role of uric acid in the pathogenesis of human cardiovascular disease, Heart 99(11) (2013) 759-66.\u003c/li\u003e\n\u003cli\u003eM. Kanbay, M.I. Yilmaz, A. Sonmez, Y. Solak, M. Saglam, E. Cakir, H.U. Unal, E. Arslan, S. Verim, M. Madero, K. Caglar, Y. Oguz, K. McFann, R.J. Johnson, Serum Uric Acid Independently Predicts Cardiovascular Events in Advanced Nephropathy, American Journal of Nephrology 36(4) (2012) 324-331.\u003c/li\u003e\n\u003cli\u003eA. Toda, Y. Ishizaka, M. Tani, M. Yamakado, Hyperuricemia Is a Significant Risk Factor for the Onset of Chronic Kidney Disease, Nephron Clinical Practice 126(1) (2014) 33-38.\u003c/li\u003e\n\u003cli\u003eW.Y. Chen, Y.P. Fu, M. Zhou, The bidirectional relationship between metabolic syndrome and hyperuricemia in China: A longitudinal study from CHARLS, Endocrine 76(1) (2022) 62-69.\u003c/li\u003e\n\u003cli\u003eX. Yang, J. Gu, H. Lv, H. Li, Y. Cheng, Y. Liu, Y. Jiang, Uric acid induced inflammatory responses in endothelial cells via up-regulating(pro)renin receptor, Biomedicine \u0026amp; Pharmacotherapy 109 (2019) 1163-1170.\u003c/li\u003e\n\u003cli\u003eA. Mandurino-Mirizzi, S. Cornara, A. Somaschini, A. Demarchi, M. Galazzi, S. Puccio, C. Montalto, G. Crimi, M. Ferlini, R. Camporotondo, M. Gnecchi, M. Ferrario, L. Oltrona-Visconti, G.M. De Ferrari, Elevated serum uric acid is associated with a greater inflammatory response and with short- and long-term mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention, Nutr Metab Cardiovasc Dis 31(2) (2021) 608-614.\u003c/li\u003e\n\u003cli\u003eW. Guo, D. Yang, D. Wu, H. Liu, S. Chen, J. Liu, L. Lei, Y. Liu, L. Rao, L. Zhang, T.R. Group, Hyperuricemia and long-term mortality in patients with acute myocardial infarction undergoing percutaneous coronary intervention, Annals of Translational Medicine 7(22) (2019) 636.\u003c/li\u003e\n\u003cli\u003eM.G. Kaya, H. Uyarel, M. Akpek, N. Kalay, M. Ergelen, E. Ayhan, T. Isik, G. Cicek, D. Elcik, \u0026Ouml;. Sahin, S.M. Cosgun, A. Oguzhan, M. Eren, C.M. Gibson, Prognostic Value of Uric Acid in Patients With ST-Elevated Myocardial Infarction Undergoing Primary Coronary Intervention, The American Journal of Cardiology 109(4) (2012) 486-491.\u003c/li\u003e\n\u003cli\u003eG. Levantesi, R.M. Marfisi, M.G. Franzosi, A.P. Maggioni, G.L. Nicolosi, C. Schweiger, M.G. Silletta, L. Tavazzi, G. Tognoni, R. Marchioli, Uric acid: A cardiovascular risk factor in patients with recent myocardial infarction, International Journal of Cardiology 167(1) (2013) 262-269.\u003c/li\u003e\n\u003cli\u003eC. Lazzeri, S. Valente, M. Chiostri, A. Sori, P. Bernardo, G.F. Gensini, 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, International Journal of Cardiology 138(2) (2010) 206-209.\u003c/li\u003e\n\u003cli\u003eC. Lazzeri, S. Valente, M. Chiostri, C. Picariello, G.F. Gensini, Uric acid in the early risk stratification of ST-elevation myocardial infarction, Intern Emerg Med 7(1) (2012) 33-9.\u003c/li\u003e\n\u003cli\u003eA. Maloberti, V. Colombo, F. Daus, L. De Censi, M.G. Abrignani, P.L. Temporelli, G. Binaghi, F. Colivicchi, M. Grimaldi, D. Gabrielli, C. Borghi, F. Oliva, Two still unanswered questions about uric acid and cardiovascular prevention: Is a specific uric acid cut-off needed? Is hypouricemic treatment able to reduce cardiovascular risk?, Nutr Metab Cardiovasc Dis 35(3) (2025) 103792.\u003c/li\u003e\n\u003cli\u003eH.J. Joo, H.S. Jeong, H. Kook, S.H. Lee, J.H. Park, S.J. Hong, C.W. Yu, D.S. Lim, Impact of hyperuricemia on clinical outcomes after percutaneous coronary intervention for in-stent restenosis, BMC Cardiovasc Disord 18(1) (2018) 114.\u003c/li\u003e\n\u003cli\u003eO. Turak, U. Canpolat, F. \u0026Ouml;zcan, M.A. Mendi, F. Oks\u0026uuml;z, A. Işleyen, O.M. G\u0026uuml;rel, S. \u0026Ccedil;ay, D. Aras, S. Aydoğdu, Usefulness of preprocedural serum uric acid level to predict restenosis of bare metal stents, Am J Cardiol 113(2) (2014) 197-202.\u003c/li\u003e\n\u003cli\u003eW. Liu, K. Ding, J. Bao, Y. Hu, Y. Gui, L. Ye, L. Wang, Relationship between uric acid to albumin ratio and in-stent restenosis in patients with coronary artery disease undergoing drug-eluting stenting, Coron Artery Dis 34(8) (2023) 589-594.\u003c/li\u003e\n\u003cli\u003eI.C. Hsieh, C.-C. Chen, M.-J. Hsieh, C.-H. Yang, D.-Y. Chen, S.-H. Chang, C.-Y. Wang, C.-H. Lee, M.-L. Tsai, Prognostic Impact of 9-Month High-Sensitivity C-Reactive Protein Levels on Long-Term Clinical Outcomes and In-Stent Restenosis in Patients at 9 Months after Drug-Eluting Stent Implantation, PLOS ONE 10(9) (2015) e0138512.\u003c/li\u003e\n\u003cli\u003eH. Jiang, W. Liu, Y. Liu, F. Cao, High levels of HB-EGF and interleukin-18 are associated with a high risk of in-stent restenosis, Anatol J Cardiol 15(11) (2015) 907-12.\u003c/li\u003e\n\u003cli\u003eX.D. Jing, X.M. Wei, S.B. Deng, J.L. Du, Y.J. Liu, Q. She, The relationship between the high-density lipoprotein (HDL)-associated sphingosine-1-phosphate (S1P) and coronary in-stent restenosis, Clin Chim Acta 446 (2015) 248-52.\u003c/li\u003e\n\u003cli\u003eS. Liang, M. Aiqun, L. Jiwu, Z. Ping, TLR3 and TLR4 as potential clinical biomarkers for in-stent restenosis in drug-eluting stents patients, Immunol Res 64(2) (2016) 424-30.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eDemographic statistics between normal and high serum uric acid groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSerum Uric Acid (SUA)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eSUA \u0026lt; 7.25 mg/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eSUA \u0026ge; 7.25 mg/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eN=829\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eN=566\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003eN=263\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e61.89\u0026plusmn;14.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e61.41\u0026plusmn;13.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e62.91\u0026plusmn;14.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.1545\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e25.59\u0026plusmn;3.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e25.46\u0026plusmn;3.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e25.87\u0026plusmn;4.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.1839\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.0440\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026nbsp;Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e704 (84.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e471 (83.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e233 (88.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026nbsp;Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e125\u0026nbsp;(15.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e95\u0026nbsp;(16.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e30\u0026nbsp;(11.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLaboratory data and examination on admission\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eSerum uric acid (mg/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e6.55\u0026plusmn;1.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e5.50\u0026plusmn;1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e8.82\u0026plusmn;1.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eeGFR (ml/min/1.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e62.68\u0026plusmn;26.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e68.10\u0026plusmn;25.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e51.00\u0026plusmn;25.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eTG (mg/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e129.31\u0026plusmn;103.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e126.39\u0026plusmn;102.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e135.95\u0026plusmn;103.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.2672\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eTotal cholesterol (mg/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e176.08\u0026plusmn;46.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e174.72\u0026plusmn;44.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e179.00\u0026plusmn;49.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.2376\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eHDL (mg/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e39.40\u0026plusmn;9.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e40.09\u0026plusmn;9.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e37.86\u0026plusmn;9.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.0033\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eLDL (mg/dL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e108.21\u0026plusmn;39.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e108.36\u0026plusmn;39.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e107.87\u0026plusmn;40.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.8750\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eHbA1c (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e7.00\u0026plusmn;1.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e6.98\u0026plusmn;1.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e7.06\u0026plusmn;1.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.5939\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eCK (U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1531.11\u0026plusmn;1939.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e1513.42\u0026plusmn;1696.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e1569.04\u0026plusmn;2382.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.7337\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eCK-MB (U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e129.21\u0026plusmn;148.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e130.59\u0026plusmn;136.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e126.25\u0026plusmn;170.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.7197\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eHigh-sensitive Troponin I (pg/mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e68.14\u0026plusmn;263.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e59.33\u0026plusmn;127.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e87.15\u0026plusmn;428.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.3115\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eLVEF (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e50.69\u0026plusmn;8.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e51.72\u0026plusmn;7.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e48.49\u0026plusmn;9.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e396 (47.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e248 (43.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e148 (56.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.0008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eDiabetes mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e300 (36.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e190 (33.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e110 (41.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.0213\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eChronic kidney insufficiency\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e83 (10.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e30 (5.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e53 (20.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eUremia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e44 (5.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e28 (4.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e16 (6.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.4969\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eHypercholesterolemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e259 (31.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e174 (30.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e85 (32.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.6484\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eHeart failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e104 (12.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e61 (10.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e43 (16.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.0242\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eAtrial fibrillation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e64 (7.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e46 (8.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e18 (6.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.5195\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eCVA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e28 (3.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e19 (3.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e9 (3.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.9614\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eGout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e92 (11.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e43 (7.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e49 (18.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of ACS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.0056\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026nbsp;STEMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e425 (51.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e311 (54.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e114 (43.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026nbsp;NSTEMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e389 (46.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e247 (43.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e142 (53.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u0026nbsp;Unstable angina\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e15 (1.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e8 (1.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e7 (2.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumbers of diseased vessels\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2.08\u0026plusmn;0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2.05\u0026plusmn;0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e2.14\u0026plusmn;0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.1360\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of CAD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.2784\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eSVD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e271 (32.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e195 (34.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;76 (28.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eDVD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e224 (27.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e150 (26.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e74 (28.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eTVD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e334 (40.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e221 (39.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e113 (42.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eImplemented stent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eBMS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e261 (31.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e174 (30.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e87 (33.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.5000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eDES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e465 (56.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e323 (57.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e142 (53.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.4064\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedications at discharge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eAspirin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e787 (94.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e537 (94.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e250 (95.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.9121\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eP2Y12 inhibitor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e808 (97.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e556 (98.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e252 (95.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.0394\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eDAPT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e772 (93.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e530 (93.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e242 (92.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.0496\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eBeta blocker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e551 (66.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e378 (66.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e173 (65.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.7755\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eStatin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e709 (85.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e487 (86.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e222 (84.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.5343\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eACEI/ARB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e485 (58.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e321 (56.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e164 (62.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.1248\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eBMI, body mass index; eGFR, estimated glomerular filtration rate; TG, triglyceride; HDL, high density lipoprotein; LDL, low density lipoprotein; HbA1c, glycated hemoglobin; CK, creatine kinase; CK-MB, creatine kinase MB; LVEF, left ventricular ejection fraction; CVA, cerebrovascular accident; ACS, acute coronary syndrome; STEMI, ST elevated myocardial infarction; NSTEMI, non-ST elevated myocardial infarction; CAD, coronary artery disease; SVD, single vessel disease; DVD, double vessel disease; TVD, triple vessel disease; BMS, bare-metal stent; DES, drug-eluting stent; DAPT, dual antiplatelet therapy; and ACEI/ARB, angiotensin converting enzyme inhibitor/angiotensin II receptor blocker\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 2.\u003c/strong\u003e Event rates during follow up between normal and high SUA groups.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 265px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSerum Uric Acid (SUA)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eSUA\u0026lt;7.25 mg/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eSUA\u0026ge;7.25 mg/dL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eN=829\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eN=566\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eN=263\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMACE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e162 (19.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e92 (16.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e70 (26.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.0005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTVR/TLR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e99 (11.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e65 (11.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e34 (12.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.5508\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ere-MI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e24 (2.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e8 (1.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e16 (6.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.0002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eACM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e37 (4.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e18 (3.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e19 (7.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e0.0087\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eMACE, major adverse cardiovascular event; TVR, target vessel revascularization; TLR, target lesion revascularization; MI, myocardial infarction; and ACM, all-cause mortality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003eUnivariable and multivariable logistic regression models to predict major adverse cardiovascular events.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnivariable model\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultivariable model*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 19px;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 19px;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.0087\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.977\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.935\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.3157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.731\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.465\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.1736\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSUA \u0026ge;7.25 mg/dL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.869\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.313\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e2.660\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.0005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.639\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.084\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e2.477\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.0191\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSUA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e1.159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e1.066\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e1.259\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.0005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLVEF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.974\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.953\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.996\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.0211\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypertension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.837\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.295\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e2.604\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.0006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes mellitus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.694\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e2.399\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.0030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChronic kidney insufficiency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e2.475\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.518\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e4.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.0003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUremia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e4.607\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e2.482\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e8.552\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e2.692\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.245\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e5.820\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.0118\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypercholesterolemia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.727\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.518\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.7932\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeart failure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e2.147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.363\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e3.384\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.0010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAtrial fibrillation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e2.526\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.468\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e4.347\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.0008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCVA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e2.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.890\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e4.521\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.0930\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of ACS during admission\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSTEMI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.452\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.466\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.1859\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNSTEMI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.926\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e2.975\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.8974\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnstable angina\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 37px;\"\u003e\n \u003cp\u003eRef.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of diseased vessels\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.748\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.405\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e2.174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.716\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.334\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e2.208\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026lt;.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStent (BMS/DES)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.752\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.494\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.1844\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.720\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e2.451\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.0027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.508\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.359\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.719\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.591\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.394\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.888\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.0114\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAspirin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.669\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.329\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.361\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.2670\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP2Y12 inhibitor\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.343\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e3.112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.9543\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDAPT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.728\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.388\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.366\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.3234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBeta blocker\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.944\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.658\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.356\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.7561\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStatin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.810\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.507\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.293\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.3774\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eACEI/ARB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.916\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e0.648\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e1.296\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e0.6216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eOR: odds ratio; CI: confidence interval; BMI, body mass index; SUA, serum uric acid; LVEF, left ventricular ejection fraction; CVA, cerebrovascular accident; STEMI, ST elevated myocardial infarction; NSTEMI, non-ST elevated myocardial infarction; BMS, bare-metal stent; DES, drug-eluting stent; ACS, acute coronary syndrome; DAPT, dual antiplatelet therapy; and ACEI/ARB, angiotensin converting enzyme inhibitor/angiotensin II receptor blocker.\u003c/p\u003e\n\u003cp\u003e* Stepwise backward model for the factors: age, SUA \u0026ge; 7.25 mg/dL, LVEF, hypertension, diabetes mellitus, chronic kidney insufficiency, uremia, heart failure, atrial fibrillation, BMS, DES and number of diseased vessels.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u0026nbsp;\u003c/strong\u003eThe univariable and multivariable COX regression models predict MACE, TVR/TLR, re-MI, and all ACM.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"95%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnivariable model\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultiple model*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003eHR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003eHR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMACE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e1.489\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e1.090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e2.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.0123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e1.399\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e1.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e1.912\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.0350\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTVR/TLR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e1.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.684\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e1.569\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.8684\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.976\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.644\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e1.480\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.9101\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ere-MI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e3.935\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e1.683\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e9.203\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.0016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e3.758\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e1.605\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e8.799\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.0023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eA\u003c/strong\u003e\u003cstrong\u003eCM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e2.049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e1.074\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e3.907\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.0294\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e1.956\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e1.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e3.753\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.0438\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eMACE, major adverse cardiovascular event; TVR, target vessel revascularization; TLR, target lesion revascularization; MI, myocardial infarction; ACM, all-cause mortality; SUA, serum uric acid; and DES, drug-eluting stent.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSUA \u0026lt;7.25 ng/mL served as the reference.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e*\u003c/sup\u003eAdjusted for age, uremia, DES, and number of diseased vessels.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Serum Uric Acid, Major Adverse Cardiovascular Events, Recurrent Myocardial Infarction, Acute Coronary Syndrome","lastPublishedDoi":"10.21203/rs.3.rs-7514499/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7514499/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e\u003cp\u003eAcute coronary syndrome (ACS) is a major cause of morbidity and mortality worldwide. Identifying biomarkers that predict outcomes is essential for guiding management. This study evaluated whether elevated serum uric acid (SUA) is associated with increased risks of major adverse cardiovascular events (MACE), recurrent myocardial infarction (re-MI), and all-cause mortality (ACM) in patients with ACS.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e\u003cp\u003eThis retrospective cohort study enrolled 829 inpatients with ACS admitted to a tertiary referral hospital in Taiwan from 2015 to 2019. Patients were divided into normal (\u0026lt;\u0026thinsp;7.25 mg/dL, n\u0026thinsp;=\u0026thinsp;566) and high (\u0026ge;\u0026thinsp;7.25 mg/dL, n\u0026thinsp;=\u0026thinsp;263) SUA groups based on a receiver operating characteristic\u0026ndash;derived cutoff. All patients received standard ACS care, and SUA levels were retrospectively analyzed. The primary outcome was major adverse cardiovascular events (MACE), defined as all-cause mortality (ACM), re-MI, and target lesion/vessel revascularization (TLR/TVR), assessed up to 60 months. Kaplan\u0026ndash;Meier survival analysis, logistic regression, and Cox proportional hazards regression were applied.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e\u003cp\u003eThe overall rates of MACE (19.54%), re-MI (2.9%), and ACM (4.46%) were higher in the high SUA group compared with the normal SUA group (MACE: 26.62% vs. 16.25%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0005; re-MI: 6.08% vs. 1.41%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0002; ACM: 7.22% vs. 3.18%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0087). No significant difference was observed in TLR/TVR (11.94%) between groups (11.48% vs. 12.93%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.5508). Kaplan\u0026ndash;Meier analysis at 60 months showed higher event-free rates for MACE, re-MI, and ACM in the normal SUA group (log-rank \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0117, 0.0006, and 0.0261, respectively). Multivariable logistic regression demonstrated an association between SUA\u0026thinsp;\u0026ge;\u0026thinsp;7.25 mg/dL and increased MACE (odds ratio\u0026thinsp;=\u0026thinsp;1.639, 95% confidence interval [CI]\u0026thinsp;=\u0026thinsp;1.084\u0026ndash;2.477, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0191). Cox regression revealed higher risks of MACE (hazard ratio [HR]\u0026thinsp;=\u0026thinsp;1.399, 95% CI\u0026thinsp;=\u0026thinsp;1.024\u0026ndash;1.191, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0350), re-MI (HR\u0026thinsp;=\u0026thinsp;3.758, 95% CI\u0026thinsp;=\u0026thinsp;1.605\u0026ndash;8.799, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0023), and ACM (HR\u0026thinsp;=\u0026thinsp;1.956, 95% CI\u0026thinsp;=\u0026thinsp;1.019\u0026ndash;3.753, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0438) in the high SUA group after adjustment for age, uremia, drug-eluting stent, and number of diseased vessels.\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e\u003cp\u003eElevated SUA is associated with increased risks of MACE, re-MI, and ACM in patients with ACS. Routine SUA assessment may help identify high-risk individuals for closer monitoring and tailored management.\u003c/p\u003e\u003ch2\u003eClinical trial number:\u003c/h2\u003e\u003cp\u003eNot applicable.\u003c/p\u003e","manuscriptTitle":"The Influence of Serum Uric Acid on Risks of Major Adverse Cardiovascular Events in Patients with Acute Coronary Syndrome","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-17 18:44:34","doi":"10.21203/rs.3.rs-7514499/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-23T11:32:55+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-22T18:21:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-16T20:41:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"72286609678080672437037589384756913096","date":"2025-09-12T05:16:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"127971322719204176283751709853946744337","date":"2025-09-10T17:38:33+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-09T21:55:25+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-09T12:27:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-09T05:00:03+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-09T04:58:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2025-09-02T07:10:11+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1bc77037-d83b-4f61-9305-62ef05f5b492","owner":[],"postedDate":"September 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-01T16:10:10+00:00","versionOfRecord":{"articleIdentity":"rs-7514499","link":"https://doi.org/10.1186/s12872-025-05322-2","journal":{"identity":"bmc-cardiovascular-disorders","isVorOnly":false,"title":"BMC Cardiovascular Disorders"},"publishedOn":"2025-11-25 15:58:05","publishedOnDateReadable":"November 25th, 2025"},"versionCreatedAt":"2025-09-17 18:44:34","video":"","vorDoi":"10.1186/s12872-025-05322-2","vorDoiUrl":"https://doi.org/10.1186/s12872-025-05322-2","workflowStages":[]},"version":"v1","identity":"rs-7514499","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7514499","identity":"rs-7514499","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}