Impact of Urate-Lowering Therapy after Percutaneous Coronary Intervention on the Long- Term Prognosis of Patients with Hyperuricemia

Background Hyperuricemia (HUA) frequently coexists with coronary artery disease (CAD) and is linked to adverse cardiovascular outcomes. The long-term impact of urate-lowering therapy (ULT) on clinical outcomes, including all-cause mortality and major adverse cardiovascular events (MACEs), in CAD patients after percutaneous coronary intervention (PCI) has not been determined. That was the aim of this study.

Material and methods In this retrospective cohort study, we included 649 patients with HUA who underwent PCI between July 2014 and May 2020. Patients who received standardized ULT for at least one month post-PCI were assigned to the treatment group, while those untreated or nonadherent were assigned to the non-treatment group. Outcomes were assessed using Kaplan–Meier survival curves, multivariate Cox regression models, and propensity score matching. Preoperative and postoperative cardiac function, including left ventricular ejection fraction and right ventricular systolic pressure (RVSP), was evaluated.

Results Over a median follow-up of 6.32 years, the incidence of all-cause mortality was 30.41 per 1,000 personyears, and MACEs occurred at a rate of 45.90 per 1,000 person-years. ULT was associated with a significant reduction in all-cause mortality (hazard ratio [HR]: 0.915; 95 % confidence interval [CI]: 0.645–0.998) and MACEs (HR: 0.887; 95 % CI: 0.661–0.990). Subgroup and sensitivity analyses confirmed these benefits, regardless of baseline uric acid (UA) concentrations or early UA normalization.
Notably, ULT was most effective in reducing cardiovascular mortality and myocardial infarction, with no significant effect on stroke or heart failure. Cardiac function in the treatment group improved post- PCI, with significant improvements in diastolic function and RVSP. In a sensitivity analysis using propensity score matching, the protective effect of ULT on both all-cause mortality and MACEs remained robust, reinforcing the conclusions of the primary analyses.

Conclusion Early initiation of ULT in patients with HUA after PCI is associated with improved long-term survival, reduced MACEs, and better cardiac function. These findings underscore the clinical value of ULT.

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