Background While the relationship between serum uric acid (SUA) and coronary artery disease (CAD) remains controversial, emerging evidence suggests a particularly significant association in patients lacking traditional cardiovascular risk factors. The specific role of hyperuricemia in determining CAD severity in non-hypertensive, non-diabetic populations warrants further investigation. Methods In this retrospective cohort study, we analyzed 716 consecutive CAD patients undergoing percutaneous coronary intervention (PCI), with a focus on 279 individuals without hypertension or diabetes. We employed multivariable logistic regression and stratified analyses to assess the independent association between SUA levels and multiple stent implantation (≥ 2 stents), a robust indicator of CAD complexity, and prognosis. Hyperuricemia was defined using gender-specific thresholds (> 420 μmol/L for males and postmenopausal females; > 360 μmol/L for premenopausal females). Results In the overall cohort, multivessel disease (OR = 2.27, 95% CI 1.94–3.96, p < 0.001) and diabetes (OR = 1.47, 95% CI 1.05–2.07, p = 0.027) independently predicted multiple stent placement. Notably, in the non-hypertensive, non-diabetic subgroup, hyperuricemia emerged as a strong independent predictor (OR = 4.62, 95% CI 1.93–11.07, p = 0.001), exceeding the predictive value of multivessel disease (OR = 3.16, 95% CI 1.78–5.55, p < 0.001). No significant association was observed between SUA levels and stent number in the broader cohort. Conclusions Elevated serum uric acid independently predicts complex coronary lesions requiring multiple stent placements in non-hypertensive, non-diabetic CAD patients. These findings suggest that uric acid assessment may enhance risk stratification in this specific patient population, warranting further investigation into its clinical implications.<Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry nameend="c2" namest="c1"> Key Points • Elevated serum uric acid is an independent predictor of complex coronary lesions requiring multiple stent placements in non-hypertensive, non-diabetic patients with coronary artery disease, highlighting its potential role in risk stratification for this specific population. </entry> </row> </tbody> </tgroup> </Table> Graphical Abstract Figure S1. Correlation between serum uric acid and cardiometabolic risk factors. The scatter plots illustrate the relationship between serum uric acid levels (x-axis) and various parameters (y-axis). A significant positive correlation was found between serum uric acid and both Body Mass Index (BMI; r=0.305, p < 0.001) and triglycerides (r=0.354, p < 0.001). No significant correlations were observed for fasting blood glucose, low-density lipoprotein cholesterol (LDL-C), total cholesterol, or the number of implanted stents (p > 0.05). The Spearman correlation coefficient  r and p-value are shown for each plot.

Elevated serum uric acid as an independent risk factor for multiple stent placement in non-hypertensive, non-diabetic patients with coronary artery disease: a retrospective cohort analysis

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发表日期：

2025年9月24日

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Qingyan Li,
Jianguo Li,
Mengwen Niu,
Tianshu Chu,
Lemei An

摘要

Background

While the relationship between serum uric acid (SUA) and coronary artery disease (CAD) remains controversial, emerging evidence suggests a particularly significant association in patients lacking traditional cardiovascular risk factors. The specific role of hyperuricemia in determining CAD severity in non-hypertensive, non-diabetic populations warrants further investigation.

Methods

In this retrospective cohort study, we analyzed 716 consecutive CAD patients undergoing percutaneous coronary intervention (PCI), with a focus on 279 individuals without hypertension or diabetes. We employed multivariable logistic regression and stratified analyses to assess the independent association between SUA levels and multiple stent implantation (≥ 2 stents), a robust indicator of CAD complexity, and prognosis. Hyperuricemia was defined using gender-specific thresholds (> 420 μmol/L for males and postmenopausal females; > 360 μmol/L for premenopausal females).

Results

In the overall cohort, multivessel disease (OR = 2.27, 95% CI 1.94–3.96, p < 0.001) and diabetes (OR = 1.47, 95% CI 1.05–2.07, p = 0.027) independently predicted multiple stent placement. Notably, in the non-hypertensive, non-diabetic subgroup, hyperuricemia emerged as a strong independent predictor (OR = 4.62, 95% CI 1.93–11.07, p = 0.001), exceeding the predictive value of multivessel disease (OR = 3.16, 95% CI 1.78–5.55, p < 0.001). No significant association was observed between SUA levels and stent number in the broader cohort.

Conclusions

Elevated serum uric acid independently predicts complex coronary lesions requiring multiple stent placements in non-hypertensive, non-diabetic CAD patients. These findings suggest that uric acid assessment may enhance risk stratification in this specific patient population, warranting further investigation into its clinical implications.

Key Points

• Elevated serum uric acid is an independent predictor of complex coronary lesions requiring multiple stent placements in non-hypertensive, non-diabetic patients with coronary artery disease, highlighting its potential role in risk stratification for this specific population.

Graphical Abstract

Figure S1. Correlation between serum uric acid and cardiometabolic risk factors. The scatter plots illustrate the relationship between serum uric acid levels (x-axis) and various parameters (y-axis). A significant positive correlation was found between serum uric acid and both Body Mass Index (BMI; r=0.305, p < 0.001) and triglycerides (r=0.354, p < 0.001). No significant correlations were observed for fasting blood glucose, low-density lipoprotein cholesterol (LDL-C), total cholesterol, or the number of implanted stents (p > 0.05). The Spearman correlation coefficient r and p-value are shown for each plot.