What is the clinical evidence from this study?

Study design: Cohort. Population: Acute myocardial infarction with heart failure with preserved ejection fraction (HFpEF) (n=757). Intervention: High serum uric acid (Hyperuricemia) vs. Normal serum uric acid. Primary outcome: All-cause mortality (HR 1.5, 95% CI 1.03-2.19, p=0.033).

November 10, 2025Frontiers in Cardiovascular Medicine1 citationsOpen Access

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

Q: What does this research mean for the field?

Hyperuricemia is independently associated with a 1.5-fold increased risk of all-cause mortality compared to normal uric acid levels in patients with acute myocardial infarction and heart failure with preserved ejection fraction. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

SKSoohyun KimSt. Mary's Hospital KLKwan Yong LeeSt. Mary's Hospital KKKyung An KimGeneral / Preventive / Lipids

Key Result

Hyperuricemia was independently associated with an increased risk of all-cause mortality (HR 1.5) compared to normal uric acid levels in patients with acute myocardial infarction and HFpEF.

Study Design

Type

Cohort (n=757)

Multicenter

Yes

Structured PICO

Does hyperuricemia predict all-cause mortality in patients with acute myocardial infarction accompanied by heart failure with preserved ejection fraction?

Population

757 patients with acute myocardial infarction undergoing percutaneous coronary intervention with drug-eluting stents and concomitant heart failure with preserved ejection fraction (LVEF ≥50% and ESC 2021 criteria), mean age 63.5, 29.1% female, based in Korea.

Intervention

High serum uric acid (hyperuricemia, defined as >6.9 mg/dL in men and >5.4 mg/dL in women at the time of AMI diagnosis)

Comparator

Normal serum uric acid (≤6.9 mg/dL in men and ≤5.4 mg/dL in women)

Outcome

All-cause mortalityhard clinical

In patients with HFpEF following an acute myocardial infarction, elevated serum uric acid is an independent predictor of long-term all-cause mortality.

Main Result

Effect estimate: HR 1.5 (95% CI 1.03-2.19)

Absolute Event Rate: 32.9% vs 15.5%

p-value: p=0.033

Limitations

Observational registry-based study where residual confounding cannot be excluded despite adjustment.
Serum uric acid levels were only measured at baseline, lacking data on temporal changes or treatment.
Information on gout and uric acid-lowering medications was not available.
Cohort was derived from an acute MI population rather than an HFpEF registry, so HF symptoms were not collected.
Excluded approximately 40% of eligible patients due to missing baseline serum uric acid measurements.
Relatively low proportion of women in the cohort compared to typical HFpEF populations.

Abstract

Background Heart failure with preserved ejection fraction (HFpEF) is defined as presenting with clinical symptoms and signs of heart failure with a concomitant left ventricular ejection fraction ≥50%. However, the prognostic role of serum uric acid in HFpEF is not well understood. Methods In total, 757 patients with HFpEF and acute myocardial infarction were included in the analysis. Hyperuricemia was defined as a serum uric acid level 6.9 mg/dL in men and 5.4 mg/dL in women at the time of diagnosis of acute myocardial infarction. The primary outcome was all-cause mortality. Results Among the enrolled patients, 164 and 593 were placed into the high uric acid and normal uric acid groups, respectively. After a median follow up of 4.8 years interquartile range: 3.2–7.1, 54 (32.9%) in the high serum uric acid group and 92 (15.5%) in the normal serum uric acid group had died. Hyperuricemia was independently associated with all-cause mortality ( p 0.001) and cardiovascular death 73 (12.3%) vs. 44 (26.8%); p 0.001. The increased risk of mortality remained consistent in the multivariate Cox proportional hazards model (hazard ratio: 1.5; 95% confidence interval: 1.03–2.19; p = 0.033). After classifying the enrolled patients according to their Heart Failure Association-Pre-test assessment, Echocardiography and natriuretic peptide, Functional testing, and Final etiological work-up (HFA-PEFF) score (366 with a HFA-PEFF score 3 and 391 with a HFA-PEFF score ≥3), hyperuricemia was also found to be associated with all-cause mortality in patients with a score greater than the intermediate score (≥3 points) ( p 0.001). Conclusions In a cohort with acute myocardial infarction, hyperuricemia was independently associated with all-cause mortality in patients with HFpEF. Clinical Trial Registration ClinicalTrials.gov , COREA-AMI NCT02806102.

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