TAPCHfYDaOCLAMSANGlOS Tap 12-567/2017
Lien quan giira nong do acid uric huyet tuong va miic do ton thuong dong mach vanh theo thang diim Gensini
Relation between uric acid plasma level with coronary artery lesions foward to Gensini scores
Bui Thi Thu Hirong , Nguyen Van Duy , Trudng Bgi hgc YDugc - Dgi hoc Thdi Nguyen Nguyin Tien Dung", Dang Van Minh'* '"Benh vien Trung uang Thdi Nguyen Tom tat
l^uc tiiu: Lien quan giUa ndng dp acid uric huyet tuang vdi mQc dp tdn thuong dpng maeh vanh theo thang diem Gensini va gia t n eda xet nghiem nay trong d i n h gia mQe dp tdn thuang, dieu tn benh machvanh va ti&n luang benh la c a s d d e thuc hien nghien cUu nay. £)d/'fuangvap/jt/angphdp; SQdung phuang phap nghien cQu md t l cat ngang tren 93 benh nhan dupc chup dong maeh vanh ed hep mpt trong eae nhlnh ddng maeh vanh chfnh v l dupe dieu tn tai Khoa Tim Mach, Benh vien Trung UOng Thli Nguyen. Kit qud: Ndng dp acid uric d benh nhan benh dpng mach vanh cd yeu td nguy cO gdm hut thudc la, dai thao dudng, rdi loan ehuyen hda lipid eao hon nhdm khdng cd cle yeu t d nguy cO nay, su khac biet cd y nghta thong k§ vdi p<0,05. 6 benh nhan ed yeu t d nguy cO beo ph) (BMI > 23) va tang huyet ap ed ndng dp acid uric cao han nhdm khdng cd cac yeu to nguy ca nly, tuy nhien sQ khac biet khdng ed y nghTa thdng ke vdi p>0,05; benh nh^n b§nh dpng mach vanh trong nghien cQu cd ty le dau nguc khdng dn dinh cao nhat ehiem 60,6%, nhoi mau ca tim chiem 29,9% v l dau nguc dn dinh chiem tJ' le thap nhat 8,5%; thang diem Gensini danh g i l tdn thuong tuong Qng cd sU khac biet giQa cac nhdm benh n h i n benh ddng mach vanh trong nghien cQu co y nghTa vdi p<0,05; cd sU khac biet v^ ndng dp acid uric trung blnh huyet tUang giQa cae vj trf hep ddng mach vanh, hep c l hai ddng mach vanh trai va phli cao han so vdi nhdm ehi hep mpt b^n ed y nghTa vdi p<0,05; nong dp acid uric huyet tuong tang dan theo eac nhdm benh nhan tdn thuang dpng maeh v i n h mQc dd nhe, trung binh va nang (p<0,05);
CO mdi tuong quan thuan chat che giQa ndng dd acid uric huyet tuang vdi diem sd Gensini danh gia mUe dd tdn thQang dpng mach vanh (r = 0,6, p<0,0001). Kit ludn: Ndng dd acid uric huyet tUang cd gia trj tien lupng mQc dp nang eda tdn thUOng ddng mach v i n h .
Tdkhda: Acid uric, benh ddng maeh vanh, chup dpng mach vanh.
Summary
Objective: The relation between serum levels of plasma uric acid level w/ith coronary artery lesions and the value of this test in monitoring the treatment of coronary artery disease was the basis of this study. Subject and method: A cross-sectional, descriptive study in 93 coronary disease patients with coronary stenosis of one of the main tributaries treated at the Cardiology Departement, Thai Nguyen National Hospital. Result: Uric acid levels in patients of coronary artery disease who had risk faaor like smoking, diabetes, lipid metabolism disorders was higher than patients without these risk factors, the difference was statistically significant with p<0.05. In patients had risk factors for obesity (BMI a 23) and
Ngdynhdnbdi. 10/4/2017, ngdy chdp nhdn ddng. 19/5/2017
Ngu&i phdn hdi: BHi Thl Thu Huong, Email. huongbui979@gmail com - Tru&ng Dai hoc YDime - Bqi hgc Thai Nguyen
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vo1.12-N°7/2017 hypertension, the uric acid levels were higher than those patients without these risk factors, however the difference was not statistically significant (p>0.05). The patients of unstable chest pain were accounted for 60.6%, of myocardial infarction were about 29.9%, and of chest pain were 8.5%. Gensini scale vulnerability assessment corresponded to the difference between the groups for coronary disease patients In the study and it was significant with p<0.05. There were differences in the average uric acid levels in term of locations of coronary stenosis: Significantly higher in patients with both left and right coronary stenosis than those having only left or right stenosis (p<0.05). Uric acid levels in plasma increased with the patient group from mild, moderate and severe (p<0.05). There was a strong positive correlation between serum uric acid level with Gensini score. Conclusion: Uric acid levels in plasma had prognostic value of severity of coronary lesions.
Keywords: Uric acid, coronary artery disease, coronary angiography.
1. Dat va n de
Nhieu nghien cUu gan d l y d l eho thay acid uric I I yeu t d nguy ea ddc lap gay benh tim mach. Mdi lien quan nay dupc g i l i thfch theo hai each: Tang acid uric I I hau q u i eua q u i trinh benh ly, acid uric ed boat tfnh ehdng oxid hda do do d ngudi benh tim mach se gia t i n g acid uric de ehdng lai peroxid lipid, vi the tang acid uric la hau qua cda qua trinh benh ly [2]. Ndng dp acid uric huyet tuang t i n g eao kich thfch phdng thfch cae gde tU do, hoat hda cle t d b l o viem va sU ket dinh phan tQ do q u i trinh viem gay tdn thuong Idp ndi mac mach mau. NhU vay, acid urie ed tham gia trong co che benh sinh cua bdnh tim mach, tang huyet ap v l benh than.
Theo ele nghien cQu gan day, acid uric cd t h ^ I I nguyen nhan cua benh tim va benh vQa xa ddng maeh ngay e l ddi vdi nhQng ngUdi trd tudi khdng ed yeu t d rui ro nao khIc ve benh tim. Theo dQ lieu edng bd tai Hdi nghj Au c h l u European Congress of Rheumatology thi cU mdi dp gia tang 1 mg/dl cua mQc acid urie trong m l u nguy ca bj benh tim va benh vUa xo ddng mach se tang 15 phan t r i m ) . Trong mdt nghien cQu khac eua I Home v l cdng sQ nam 2009 theo ddi acid urie tren 417.734 benh nhan, ket q u i cho thay nguy ca nhdi m l u ea tim cap tfnh, tai bien mach m l u nao va suy tim t i n g cao khi lUpng acid uric trong mau t i n g . Tai Viet Nam, h l n g trieu ngudi bj benh mach vanh, 10% xd vong do nhdi mau ea tim (NMCT). Xet nghiem acid uric huyet tUOng va danh g i l tdn thuong ddng mach vanh (OMV) theo thang diem Gensini la nhdng van de cdn It duoc nghien cQu trong benh ly maeh vanh d Viet Nam. Tim hieu sQ thay ddi acid uric huyet
tuong v l g i l tri cua xet nghiem nay trong chan doan va theo ddi benh mach vanh la eo sd de ehung toi thUe hien nghien cQu nay vdi mue tidu: Phdn tich moi lien quan gida nong do acid uric huyit tdang vdi mdc do tdn thdong ddng mgch vdnh theo bdng diem Gensini d binh nhdn binh mgch vdnh tgi Khoa Tim mgch - Binh viin Trung ddng Thdi Nguyin.
2. Ddi tUdng va phUcfng phap 2.7. Ddi tdgng
Benh nhan benh maeh vanh gdm dau nguc dn
<^nh (ONOO) va hdi chQng vanh cap (HCVQ: Dau ngiic khdng dn dinh (ONKOD), nhdi m l u ca tim (NMCT) ddgc ehi djnh ehup ddng maeh vanh v l ed hep it nhat mdt trong eae nhanh ddng maeh vanh ehinh tai Khoa Tim mach - Bdnh vidn Trung Qong Thai Nguyen.
Tieu chudn logi trd
Opt gut cap, suy than, ed phu t o l n than, benh ly nhiem khuan, benh cap tinh nang, nghidn rupu, cac benh he t h d n g , benh tuyen giap, dang sQ dung thude g l y rdi loan acid urie (thudc dieu tri ung thU, salicylate, loi tieu, ethambutol, pyrazinamid, corticoid, allopunnol).
2.2. Thdi gian va dia diem
Oia diem nghien cUu: Khoa Tim mach - Benh vien Trung uang T h l i Nguyen.
Thdi gian nghien cQu: 1 /2016 -11/2016.
2.3. Phddng phap
Phuang p h I p nghien cUu md t l , thiet ke nghien eQu c^t ngang.
TAP CHl Y DUOC L A M S A N G 108 Tap 12-So 7/2017
2.4. Cac ky thuat sddung trong nghien cdu nghiem dupe thue hien tai Khoa Sinh hda va Khoa r.- u I . - - * . ._. • - - . Huyet hoc-Benh vien Trung uong Thai Nguyen.
Oinh luong nong d d add urie tren may xet / . . . a y a y
nghiem AU640 eua hang Olympus, N h l t B i n . Cac xet ^*''^P ^ ^ " 9 maeh vanh ehpn Ipc theo khuyen e l o eua Hpi Tim Maeh Hoa Ky [6].
Phan dd nang cda ton thUomg dong mach vanh theo diem so Gensini [1], [10]
Tinh diem theo mii'c do hep 25%-49%
50%-75%
75%-89%
90%-98%
99%: 16 Tie hoan toa
1 diem 2didm 4 diem 8 diem diem n: 32 diem
He so: Theo vj tri ton thUiAig -Than chung x 5;
- Odng maeh lien that trudc: Ooan gan x 2,5; doan giQa x1,5; vung mdm x l ; nhlnh cheo 1 x 1; nhanh cheo 2 x 0,5;
-Odng maeh mu:Doan gan x 2,5; doan x a x i ; nhanh b d x 1; n h l n h sau dudi x l ; nhanh sau ben x 0,5;
- Dpng maeh vanh p h l i x 1
Oiem Gensini cda benh nhan la t d n g sd diem Gensini cda toan bd ele tdn thQang sau khi nhan he sd [5].
2.5. Phddng phap xdl^sdli§u:Y.d ly sd lieu theo phuong p h I p thdng ke y hpe. SQ dung phan mem SPSS 20.0.
2.6. Nghien cdu dim bSo van de dao ddc trong nghien cdU 3. Kitqud
BSng 1 . Dac di^'m ddi tUOng nghien cuTu Dac diem
Tuoi trung binh (nam)
X ± S D 69,4 + 12,9 n
Niiom tuoi
Gidi
S60
>60 Nam NCr
28 65 59 33
T^le%
30,1 69,9 64,1 35,9
Nhdn xet: Tham gia nghien eUu gdm 93 benh nhan benh BMV ed tuoi trung binh I I 69,4 ± 12,9 trong dd benh nhan tren 60 tudi ehiem phan Idn 69,9%, tudi dUdi 60 chiem ty le thap 30,1% v l chu yeu d nam gidi chiem 64,1%, nQ chiem 35,9%.
Bdng 2 . Phan bo nong do acid uric huyet tUOng it b^nh nhan DMV theo yeu to nguy cor Yeu to nguy ctf
BMI Hut thuoc la Sal thao dtrclng Tang huyet ap Roi loan chuyen hoa lipid
> 2 3 ( n = 1 8 )
< 23 (n = 75) Co (n = 57) Khong (n = 36)
C6(n = 54) Khong (n = 39)
C6(n = 41) Khong(n = 52)
C6 (n = 56) Khong(n = 37)
Nong do acid uric (|imol/l) 441,7 ±148,8 425,6 ±115,4 482,9 ±119,1
342,9 ±62,7 468,4 ±138,6 373,8 ±61,6 444,3 ±150,7 416,5 ±92,7 486,3 ±117,8 341,6±61,4
P
>0,05
<0,05
<0,05
>0,05
<0,05
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY
Nhdn xit. Ndng dp acid uric d benh nhan benh OMV ed ydu t d nguy co gdm hdt thude 11, dai thao dudng, rdi loan chuyen hda (RLCH) lipid eao hon nhdm khdng ed c l e yeu t d nguy ea nay, sU khae biet co y nghTa thdng ke vdi p<0,05. CJ nhQng benh n h i n cd yeu t d nguy ea beo phi (BMI £ 23) va t i n g huyet ap co ndng dd acid urie eao han nhdm khdng cd ele ydu t d nguy ea n l y , tuy nhien sU khac biet khdng cd y nghia thdng ke vdi p>0,05.
Being 3. Phdn loai b e n h nhan b^nh d o n g mach v a n h Phan nhom benli DMV
OaungJcondinh Dau nguc khong on djnh Nho! mau CO tim
So luong 8 57 28
T ^ l e % 8,5 60,6 29,9
Nhdn xit: Benh nhan benh DMV trong nghidn cQu cd X')/ le ONKOO cao nhat chiem 60,6%, NMCT chiem 29,9% va DNOO chiem ty le thap nhat 8,5%.
B i n g 4 . Thang d i e m Gensini d a n h gia t o n t h U i m g D M V d d d i tUoing nghien cUu
Plian nhom
Oau nguc on dinh
HCVC
Cau ngiic khong dn ^ n h Nhoi mau cotim
Thang d i ^ m Gensini Trung binh
10,9 33,68
53,8
Trung v i 4,0 16,0 49,0
Do lech chuan 18,3 45,8 42,2 p<0,05
Nhdn xet Thang diem Gensini d i n h g i l t d n t h u o n g tUdng Ung cd sU khac biet giQa eac nhdm benh nhan benh DMV trong nghien cQu cd y nghla vdi p<0,05.
Bdng 5. Lien q u a n giuTa n o n g d d acid uric vdri mufc d o n a n g cua t o n thUtfng D M V t h e o t h a n g d i e m Gensini
IVIt^c do nang ciJa t o n thuong OMV theo thang diem Gensini Nhe (s 23 diem)
Trung binh {24 - 54 diem) Nang ( > 54 diim)
n
53 14 26
N6ng do acid uric (Mmol/1) Trung binh
388,0 410,7 521,8
D d lech chuan 92,7 77,3 144,8
P
<0,05
Nhdn xit Ndng dp acid urie huyet tUOng tang dan theo e l e nhdm benh n h i n tdn thuang OMV mde do nhe, trung binh va n l n g (p<0,05).
TAPCHlY D a o c LAM S A N G IOS Tapl2-S67/2017
SOU
700 600 500
400 300
•Ml
100
-
•
•
1
•
*•
•
• •
•
•
•
•
y = 1.636 X+366.89 r = 0.6, p<0.001
1 1 1
0 50 100 150 200 250 Dllm Gensini
Bieu d o 1. T u o n g q u a n giUa n d n g d p acid urie vdi mUc d p n l n g eda t o n t h u a n g OMV t h e o thang d i e m Gensini
Nhdn xit Cd mdi tUong quan thuan chat che glQa nong dp acid urie huyet tuang vdi diem sd Gensini danh g i l mUc dp ton thUPng OMV (r = 0,6, p<0,001).
4. Ban luan
Benh ddng maeh vanh la nguyen n h i n g l y tQ vong hang dau tren toan the gidi. Mae du hau het cle benh nhan benh OMV cd it nhat mdt trong cac yeu td nguy co tim maeh, 20% benh nhan bj benh maeh vanh khdng ed yeu t d nguy ca.
Trong nghien cQu nay chung tdi tien h l n h tren 93 benh n h i n benh ddng maeh vanh vao vien dQOc chup ddng maeh v i n h va cd hep it nhat mdt n h l n h mach vanh ehinh, chung tdi thu dQpe ket q u i sau:
Tudi trung blnh cda ddi tQpng nghien cQu 11 69,4 ± 12,9 trong dd bdnh nhan tren 60 tudi chiem phan Idn 69,9%, tudi dUdi 60 chiem ty Id thap 30,1%
va chCi yeu d nam gidl ehiem 64,1 %, nQ ehidm 35,9%.
Ket qua nay cung phiJ hpp vdi cac yeu t d nguy co ve b^nh mach vanh t h ! hut thude la la yeu t d nguy ca doc lap vdi eae yeu t d khIe [11]. Nghien cQu cua chung tdi thay d nhQng benh nhan hut thudc la cd nong dd acid uric la 482,9 + 119,1 pmol/l eao ban so vdi khdng hut thudc I I 342,9 ± 62,7Mmol/l, ed y nghia vdi p<0,05. 6 nhQng benh nhan cd d l i thao dudng thi ndng d d acid uric I I 468,4 ± 138,6pmol/l eao hon nhieu so vdi khdng ed dai thao dudng 373,8 ±
61,6pmol/l ddng thdi benh nhan cd rdi loan chuyen hda lipid thl acid urie 486,3 ± 117,8pmol/l eao hon so vdi khdng ed rdi loan m d mau la 341,6 ±61,4pmol/lcd y nghla thdng ke vdi p<0,05. NhU v l y , hut thuoc I I lien quan den eli chet eua hang trieu ngUdi. So vdi nhUng ngudi khdng hut thuoc la thi ngudi hut thudc la cd nguy ea tien den benh maeh vanh do xa vQa tdi 60%, tang 50% tU vong benh tim maeh [11 ].
Hut thudc la gay gia tang ndng dp carbon monoxid trong mau, dan tdi p h i huy te bao ndi md maeh vanh, gia tang ket tap tieu eau, t i n g nguy co hinh thanh huyet khdi tae nghen. Oai thao dQdng cd hai nhdm bien chQng ve mach mau la bien ehUng vi maeh (tdn thQdng vdng mae, benh than, tdn thuong t h i n kinh) v l bien chUng maeh mau Idn (benh dpng maeh vanh, dot quy va benh ddng mach ngoai vi), rdi loan ehuyen hda lipid da dupe nhieu nghien cQu chQng minh cd sullen quan vdi benh l;^tlm mach d i e biet I I benh maeh vanh. Acid urie I n h hUdng tren chQc nang Idp ndi mac mach m l u , oxide hda LDL va peroxid lipid do v l y tang ket dinh tieu cau, tao huyet khdi gay ra ele benh ly tim mach. Acid urie eao kich thich phdng thfch cac gde t u do, boat hda te bao viem va su ket dfnh p h l n tQdo qua trinh viem gay tdn thuong Idp ndi mac mach mau.
141
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Ket q u i nghien cUu eua ehung tdi ed sUtUOng ddng vdi eac nghien cQu khac khi so sanh ndng dp acid urie trung binh eua nhdm benh n h i n benh DMV cd rdi loan lipid mau eao hon nhdm bdnh nhan khdng ed rdi loan lipid mau, sU khIe biet cd y nghTa thdng ke vdi p<0,05 [4]. Trong nghien cUu nay ddi vdi tang huyet ap v l nguy eo beo phi (BMI > 23) mac du ket q u i acid uric d ddi tUpng cd yeu to nguy ca nay cung eao hpn nhieu so vdi khdng ed tuy nhien khdng cd y nghia thdng ke vdi p>0,05. Mae du v l y , tang huyet I p van I I yeu t d nguy co eao vdi benh maeh vanh, mdi lidn quan giQa add uric v l tang huyet ap dupe khSng djnh qua nhieu nghien cQu.
Trong nghien cUu vdi 93 benh n h i n bdnh OMV ed ty le benh nhan ONKOD eao n h l t chiem 60,6%, benh n h i n NMCT chiem 29,9% va benh n h i n ONOO ehiem t^ le thap nhat 8,5%.
Lien quan thang diem Gensini vdi nhdm benh nhdn DMV
Chung tdi ghi nhan trong nghien cQu thay thang diem Gensini tang dan d nhQng bdnh nhan ONOD, DNKOO va cao nhat d benh nhan cd NMCT, ed y nghia vdi p<0,05. NMCT chu yeu la do xO vQa ddng mach vanh (90%), m l n g xa vda tien trien dan g l y hep Idng OMV, cudi cung gay tac han. Benh canh la con OTNKOO vdi tan suat, eUdng dp va thdi gian tang dan dan tdi NMCT. Mat khac, m l n g xp vQa khdng vQng cd the bi bong ra va huyet khdi thanh lap nhanh chdng g l y nen hdi chQng vanh cap, vdi benh c I n h OTNKOO mdi xuat hien cd the dan den NMCT. Vdi DNOO thudng la xd vQa ddng mach ft hon, chic ehan nen khd tao huyet khdi nen mQe do hep ldng mach nhd hon ONKOO va NMCT. Thang diem Gensini dupe tfnh dua theo mUc dp g i l m khau kinh Idng mach v l vj trf tdn thuang OMV rat cu the, di^m c l n g eao neu hep ddng maeh cang nhieu, tae cang nhidu vi tri va cang gan nai xuat p h l t [3], [8]. VI v l y ma ket q u i nghien eQu diem Gensini tang d i n d nhdm benh nhan ONOO den HCVC vdi ONKOO va NMCT la hoan toan phd hpp.
Liin quan gida nSng do acid uric huyit tdang vdi mdc dd ndng cua ton thdong OMV theo thang diim Gensini
Benh ddng mach vanh la hep h o l e tac nghen cac ddng mach va cac maeh la ngudn eung cap oxy
va chat dinh dudng cho tim [12]. DQa vao than diem Gensini vdi 3 mUc dp tdn thuong ddng mac vanh: Nhe {<. 23 d i i m ) , trung binh (24 - 54 diem nang (> 54 diem) [12]. ChQng tdi ghi n h i n d nhdr benh DMV mUe dp nhe thi ndng dp acid urie mau I thl'p nhat, tidp den la mQe dp trung binh va ndng d acid urie cao nhat d nhdm mUe dp nang (p<0,05 Odng thdi, ehung tdi thay cd mdi tUong quan thua ehat ehe giQa ndng dp acid urie huyet tUPng vc diem sd Gensini d i n h g i l mUe dp tdn thuong OMV <
= 0,6, p<0,001). Oieu nay cd nghla la ndng dp ad uric mau tang theo mQe dp tdn thQpng cda DM tfnh theo thang diem Gensini.
5. Ket luan
Ndng dp acid huyet tQOng ed g i l tri d i n h gia v tien lupng mQe dp nang tdn thuong OMV.
6. Khuyen n g h i
Acid urie huyet tUOng can dupe col nhU mdt x*
nghiem t h u d n g quy ddi vdi bdnh nhan benh mac vanh vi day la mdt thdng tin cd g i l tri giup ch ngudl thay thudc l l m sang ed them eo sd de s6r xac djnh mQc dp tdn thQpng ddng mach v i n h .
Tai lieu t h a m khSo
1. Phan Ddng Blo Linh (2010J Nghiin cdu dgc diet ton thuang dgng mgch vdnh vd do cdng dgng mgc d binh nhdn tdng huyit dp cd binh ddng mai vdnh. Luan an Tien sy y hpe, Dai hpc Y dupe Hue.
2. Tran Van Trung, Hu^nh Thi Dung, Nguyen Hor Ha va CS (2009) Nghiin cdu ndng do acid uric huy thanh d binh nhdn ddi thdo dudng type 2 tgi Khe Ngi A BVDK tinh Binh Dfnh. Tap chf Noi khoa (' tr. 409-417.
3. Gensini GG (1983) A more meaningful scoring syste for determining the severity of coronary heart disea:
The American Journal Cardiology 51 (3): 606.
4. Levy D, Culleton BF, Larson MG et al (1999) Seru uric acid and risk for cardiovascular disease ai death: The Framingham Heart Study. Ann Inte Med 131:7-13.
5. Longo F, Kasper, Hauser, Jameson, Losealz (201 Epidemiology of Cardiovascular Disease. Harriso
TAP CHl Y DL/pC LAM SANG 108 Tap 12-S6 7/2017
Principles of internal Medicine 18th, McGraw-Hill United States.
Mendis S, Puska P, Norrving B (2011) Global atlas on cardiovascular disease prevention and control (PDF) (Isted.). Geneva: Worid Health Organization in collaboration with the Worid Heart Federation and the World Stroke Organization: 3-18.
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J Cardiovasc Surg (Torino) 48(5): 601-605.
Who (2004) Vie global burden of disease 2004 update. Who library cataloguing -in-Publication Data. Switzerland.
Viazzi F (2006) Serum uric acid as a risk factor for cardiovascular and renal disease: Aan old controversy revived. The journal of clinical hypertension 8:510-518.
10. Brican A, Veysi A, Adem A (2016) Relationship betwween osteopenic syndrome and severity of coronary artery diseasa detected with coronary angiography and Gensini csore in men. Clinical Interventions in Aging 11:377-382.
11. Gen-ML, Yi-Hwe L, Nan-Cheng Z et al (2013) Serum uric acid an independent predictor of mortality in high-risk patients with obstructive coronary artery disease: A prospective observational cohort study from the ET-CHD registry, 1997-2003. Journal of Cardiology 61 (2): 122-127.
12. Ana TT, Ana L, Jorge L et al (2013) Serum uric acid:
A forgotten prognostic maker in acute coronary syndromes?". European Heart Journal: Acute Cardiovascular Care 2(1): 44-52.
