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.

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.