INTRODUCTION Ischemic heart disease (IHD) is the generic designation for a group of pathophysiologically related syndromes resulting from myocardial ischemia- an imbalance between the supply (perfusion) and demand of the heart for oxygenated blood. In more than 90% cases, the cause of myocardial ischemia is obstructive atherosclerosis lesion in the coronary arteries. Thus IHD is often termed as Coronary Artery Disease (CAD) or Coronary Heart Disease (CHD). The most common cause of 1 myocardial ischemia is atherosclerotic disease of coronary artery (or arteries) that is sufcient to cause a regional reduction in myocardial blood ow and inadequate perfusion of the myocardium supplied by the involved coronary artery. Obesity, insulin resistance, and type 2 diabetes mellitus are increasing and are strong risk factors for IHD. Cardiovascular diseases have been gaining importance in developing countries like India recently because of increased incidence of the disease. Normal serum uric acid in male 4.0-7.0 mg/dl and in female 3.0-6.0 mg/dl . The role of uric acid as a risk factor for 3 cardiovascular disease or a prognostic factor is controversial. Uric acid is produced by the enzymatic activity of xanthine oxidase and is the nal product of purine metabolism . 4 Xanthine oxidase produces oxidants in this process that may have role in cardio-vascular diseases. Some study suggested that uric acid can cause intracellular stress and inammation leading to endothelial injury and enhancement of vasoconstrictor effect . Uric acid(2,6,8trioxypurine) is the nal 5 excretory product of purine metabolism in humans .Uric acid . can serve as important antioxidant by getting itself converted (non-enzymatically) to allantoin. It is believed that the antioxidant role of ascorbic acid in primates is replaced by uric acid ,since these animals have lost the ability to synthesize ascorbic acid. Most animals (other than primates) however, oxidize uric acid by the enzyme uricase to allantoin, where the purine ring is cleaved. Allantoin is then converted to allantoic acid and excreted in some shes. Further degradation of allantoic acid may occur to produce urea (in amphibans, most shes and some molluscs) and, later, to ammonia (in marine invertebrates) There are several studies 2 which are conducted overtime to address this issue but there is no any consistent data which suggest the relation of serum uric acid with acute myocardial infarction. Therefore this study is designed to evaluate the relation of serum uric acid in Acute MI. AIM AND OBJECTIVES To study the relationship between serum uric acid level and prognosis in indoor patients with Acute Myocardial Infarction. OBJECTIVE: 1 . To determine the relationship between serum uric acid level and major cardiovascular events in patients with acute myocardial infarction. 2. To give specic recommendations on the basis of ndings of the study. MATERIAL AND METHOD Ÿ STUDY DESIGN The present prospective study was conducted in the department of Medicine in Rohilkhand medical college and hospital from period of November 2019 to January 2020 Ÿ STUDY GROUP A total number of 100 patients of Acute Myocardial Infarction admitted in department of Medicine of Rohilkhand medical college and hospital during the study period were taken Ÿ INCLUSION CRITERIA 1. Age ≥18 years 2. All the patients of Acute Myocardial Infarction admitted within 7 days of presentation during the study period in Rohilkhand medical college and hospital. 3. Both ST segment elevation myocardial infarction (STEMI) and Non-ST segment elevation myocardial infarction (NST EMI) will be included in the study. THE PROGNOSTIC ROLE OF SERUM URIC ACID LEVEL IN INDOOR PATIENTS WITH ACUTE MYOCARDIAL INFARCTION Original Research Paper Dr. Sarda Mukund Shyam Junior Resident, General Medicine Department, Rohilkhand Medical College And Hospital, Bareilly Room Number 17, PG And Interns Hostel, Rohilkhand Medical College And Hospital, Bareilly, Uttar Pradesh 243001 Medicine Ischemic heart disease (IHD) is the generic designation for a group of pathophysiologically related syndromes resulting from myocardial ischemia- an imbalance between the supply (perfusion) and demand of the heart for oxygenated blood. In more than 90% cases, the cause of myocardial ischemia is obstructive atherosclerosis lesion in the coronary arteries. Some study suggested that uric acid can cause intracellular stress and inammation leading to endothelial injury and enhancement of vasoconstrictor effect5. There are several studies which are conducted overtime to address this issue but there is no any consistent data which suggest the relation of serum uric acid with acute myocardial infarction. Serum uric acid (SUA) levels can be measured in almost all hospitals, especially in developing countries, which have no facilities to measure other more expensive prognostic markers such as high sensitive C - reactive protein, Brain-type Natriuretic Peptide, Interleukin-6 and many others. This simple, easily available, inexpensive laboratory parameter (estimation of serum uric acid) may help in settings where facilities are lacking, can be a useful biomarker to prognosticate patients of acute myocardial infarction ABSTRACT KEYWORDS : VOLUME-9, ISSUE-2, FEBRUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Dr. Dhanakar Thakur* Associate Professor, General Medicine, Rohilkhand medical college and hospital, Bareilly *Corresponding Author Dr. Anubhav Gupta Junior Resident, General Medicine Department, Rohilkhand Medical College And Hospital, Bareilly 22 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Ÿ EXCLUSION CRITERIA 1 Any patient with the history of medical illness known to elevate uric acid level, viz a. Gout b. Chronic Renal failure c. Systemic or local infection d. Malignancy e. Repeated Blood Transfusion f. Hematological disorder g. Chronic Alcoholism 2. Patient with history of intake of- a. Hyperuricemic drug (Thiazide, Salicylate, Ethambutol, Pyrazinamide, Allopurinol). b. Impaired renal function (serum creatinine >2mg/dL). c. Had an episode of MI within 3 months. d. Had severe valvular heart disease. METHODS OF STUDY The patients admitted in department of medicine in Rohilk hand medical college and hospital with symptoms of Acute Myocardial Infarction were screened with 12 lead ECG & Trop- T and those fullling the inclusion and exclusion criteria of our study will be taken as the study subject. The study group selected will be subjected to routine blood investigation, blood sugar fasting & post prandial , fasting lipid prole, serum uric acid, Chest X-Ray, USG abdomen and echocardiography. The demographic information, cardiovascular history and risk factors(smoking, hypertension and diabetes mellitus) of patients were obtained from medical records RESULTS Out of 100 patients, 83 (83%) were males and 17 (17%) were females Accounting a ratio of M Male to Female 4.8:1. Patient's age ranged from 26- 80years More than half of patients were between 40-60 years (54%) followed by >60 (32%) and <40 (14%) years.All 100 patients in the study were subjected to 2D ECHO and we observed that 65 patients (65%) had normal left ventricle function and remaining 35 patients (35%) had LV dysfunction ranging from mild to severe. Mild LVD was found among 17% patients and moderate LVD was in 13%. Severe LVD was in 5% patients. When we compared 2D ECHO ndings with serum uric acid levels on day 1, we found clinical correlation. Abnormal uric acid was higher among whom abnormal LVF (42.9%) than normal LVF (33.8%). However, the association was statistically insignicant (p>0.05). Also on comparing 2D ECHO in the form of LVEF with outcome of patients mortality was higher among moderate and severe LVD. The association was statistically signicant (p=0.02).Study by Chen et al and Shetty et al found similar 6 7 observation when they evaluated LV dysfunction by 2D ECHO and compared with uric acid. Patients with moderate to severe LV dysfunction had high uric acid levels. When we see the distribution of uric acid, we found that abnormal uric acid was in 37% and 34% at Day 1 and Day 4 respectively. The change in the pattern of uric acid from Day 1 to Day 4 was statistically insignicant (p>0.05). Fig. 1: Correlation of LVEF with Uric acid day 1 Table-1: Correlation of outcome with LVEF Chi-square test, *Signicant Table-1 & Fig.1 shows the correlation of LVEF with outcome. Mortality was higher among moderate and severe LVD. The association was statistically signicant (p=0.02) Fig. 2: Correlation of outcome with Uric acid CONCLUSION In the present study of 100 patients with acute myocardial infarction we observed signicant correlation with various factors. Based on the ndings the conclusion drawn is: 1. In patient's with acute myocardial infarction, patients with hyperuricemia had higher mortality. 2. There was a positive correlation of outcomes with 2D Echo .. 3- There was a clinical correlation between hyperuricemia and left ventricle dysfunction which was statistically insignicant. 4- Hyperuricemia is an indicator of poor prognosis in acute myocardial infarction. RECOMMONDATION: SUA Serum uric acid levels can be measured in almost all hospitals, especially in developing countries, which have no facilities to measure other more expensive prognostic markers such as high sensitive C - reactive protein, Brain-type Natriuretic Peptide, Interleukin-6 and many others. This simple, easily available, inexpensive laboratory parameter (estimation of serum uric acid) may help in settings where facilities are lacking, can be a useful biomarker to prognosticate patients of acute myocardial infarction. Besides this, controlling hyperuricemia might also be a promising strategy for the prevention of AMI. We strongly recommend that patients with higher levels of these markers on admission should be closely monitored for AMI associated complications. To address this issue whether efcacy of serum uric acid level in these patients is signicant or not, a detailed study with large sample size may be required. Although of few limitations, we consider that our study make an important contribution, since similar studies especially inconsistent in their result. LIMITATION OF THE STUDY: 1- Major limitations of our study may be the small number of patients. VOLUME-9, ISSUE-2, FEBRUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra LVEF No. of patients Outcome p-value Expired Discharged No. % No. % Normal 65 9 13.8 56 86.2 0.02* Mild LVD 17 1 5.9 16 94.1 Moderate LVD 13 6 46.2 7 53.8 Severe LVD 5 1 20.0 4 80.0 X 23GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS 2- Most of our patients in study were male. A large study, especially with more female patients could be more informative. 3- Another limitation of the study is that we could not follow up our discharged patients. REFERENCES 1. Kumar V, Abbas AK, Fausto N, Mitchell RN. Robbins basic patho logy. 8thedition. Saunders and Elsevier publishers.2007;379-420. 2. U. Satyanarayna, U. Chakrapani. Biochemistry 3rd edi. Kolkata: 2008 chapter17, Metabolism of Nucleotides; 394. 3. Victor W. RODWELL. HARPER’S ILLUSTRSTED BIOCHEMISTRY. 30th edi. New York: McGraw Hill education; 2015. Chapter 33, Metabolism of Purine & Pyrimidine Nucleotides; 354. 4. John J. Cush .HARRISON’S PRINCIPLES OF INTERNAL MEDICINE. 19th edi. New York; 2015 chapter 393, Approach to Articular and Musculoskeletal Disorders; 2222. 5. Wasserman A, Shnell M, Boursi B, Guzner-Gur H. Prognostic signicance of serum uric acid in patients admitted to the department of medicine. The American journal of the medical sciences. 2010 Jan 31;339(1):15-21 6. Chen L, Li XL, Qiao W, Ying Z, Qin YL, Wang Y, Zeng YJ, Ke YN. Serum uric acid in patients with acute ST-elevation myocardial infarction. World journal of emergency medicine. 2012;3(1):35-9 7. Shetty S, Rao A, K. S, S R. Serum Uric Acid as a prognostic biomarker & its correlation with Killip Class in Acute Myocardial Infarction. International Journal of Biomedical Research. 2013;4(7):312 VOLUME-9, ISSUE-2, FEBRUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra 24 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS