Serum uric acid level and prognosis of acute coronary syndrome: a systematic review and dose-response meta-analysis

Background This study aims to perform a systematic review and meta-analysis evaluating the association between serum uric acid (SUA) concentrations and clinical outcomes in individuals diagnosed with acute coronary syndrome (ACS). Methods PubMed, Web of Science, Embase, and the Cochrane Library were searched up to March 2025. Stata (15.1) was employed to assess heterogeneity, perform sensitivity analyses, evaluate publication bias, and execute subgroup analyses. Results A total of 40 cohort studies involving 105,609 ACS patients were included. The results showed that patients with high serum uric acid (HSUA) had significantly higher risks of all-cause mortality [Hazard Ratio [HR] = 1.81, 95% confidence interval [CI]: 1.47–2.22, p < 0.001; Odds Ratio [OR] = 1.97, 95% CI: 1.29–2.99, p < 0.05], major adverse cardiovascular events (MACE) (HR = 1.40, 95% CI: 1.15–1.71, p < 0.05; OR=2.25, 95% CI: 1.73–2.92, p < 0.001), cardiovascular mortality (HR = 2.58, 95% CI: 1.67–3.98, p < 0.001), stroke [risk ratio (RR) = 1.27, 95% CI: 1.08–1.48, p < 0.05], and heart failure (RR = 1.90, 95% CI: 1.72–2.11, p < 0.001) compared to those with non-HSUA level. However, there was no significant effect on the risk of revascularization (RR = 1.09, 95% CI: 0.80–1.47, p = 0.594). Subgroup analyses suggested that follow-up time, type of ACS, treatment methods, and region might influence the observed associations. Additionally, SUA level was also nonlinearly related to all-cause and cardiovascular mortality. Conclusion HSUA level is strongly associated with poor clinical outcomes in ACS patients, including mortality and major cardiovascular events. Given the nonlinear relationship with mortality, SUA could serve as a potentially valuable clinical marker. However, further multicenter studies are needed to confirm these findings.