Sex specific serum uric acid is associated with complex coronary artery disease and cardiovascular outcome following percutaneous coronary intervention-a single center registry

Background Serum uric acid (sUA) has been associated with cardiovascular (CV) morbidity and mortality; however, its relationship with complex coronary artery disease (c-CAD) and long-term outcomes following percutaneous coronary intervention (PCI) remains inconclusive. Purpose To assess the association of sUA with c-CAD and to determine its prognostic value for long-term outcomes in a real-world cohort of patients undergoing PCI. Methods We analyzed 17,271 consecutive patients who underwent elective or emergent PCI at a single center between 2004 - 2022. c-CAD was defined as PCI involving at least one of the following: left main intervention, multivessel disease including the proximal left anterior descending artery, chronic total occlusion intervention, implantation of ≥3 stents, or treatment of long lesions requiring a total stent length ≥60 mm. sUA levels were categorized into sex-specific tertiles, comparing the highest tertile with the lower tertiles. Associations with c-CAD, all-cause mortality, and major adverse cardiovascular events (MACE) were assessed using multivariable logistic and Cox proportional hazards models. Results Mean age was 66 ± 12 years, and 24% of participants were women. Mean sUA levels were 6.2 ± 2.0 mg/dL in men and 5.8 ± 2.0 mg/dL in women. c-CAD was identified in 4,632 patients (27%). Multivariable model found higher odds for c-CAD with upper tertilte of sUA (OR 1.15, 95% CI 1.1–1.2; p < 0.001). Over a median follow-up of 7 years, 34% of patients died and 48% experienced MACE. Restricted cubic spline analyses demonstrated a non-linear U-shaped association between sUA and MACE (p < 0.001). sUA upper tertilte was independently associated with increased risks of all-cause mortality (HR 1.3, 95% CI 1.2–1.3) and MACE (HR 1.2, 95% CI 1.1–1.2), with stronger associations observed among women and patients aged ≥75 years. Incorporation of sUA resulted in statistically significant improvement in discrimination for MACE, with a ΔC-statistic of 0.002 (95% bootstrap percentile CI 0.0006–0.0025). Conclusions Elevated sUA levels were associated with c-CAD and adverse long-term outcomes following PCI, particularly in women and older patients. sUA may serve as a simple and clinically useful marker for risk stratification in this population.