Association between Serum Uric Acid Concentration and Angiographic Severity of Coronary Artery Disease in Diabetic Patients Presenting With Acute Coronary Syndrome

Abstract

Objective: To evaluate the association between serum uric acid (SUA) concentration and angiographic severity of coronary artery disease (CAD), primarily assessed using the continuous Gensini score, among diabetic patients presenting with acute coronary syndrome (ACS) and meeting the prespecified SUA inclusion criterion of >6.0 mg/dL. Methodology: This analytical cross-sectional study was conducted in the Department of Cardiology, Shaikh Zayed Hospital, Lahore, Pakistan, from April 8 to July 8, 2026. A total of 62 consecutive adults aged 20–60 years with diabetes mellitus, ACS, SUA >6.0 mg/dL, and diagnostic coronary angiography during the index hospitalization were included. SUA was the primary exposure, while continuous Gensini score was the primary measure of angiographic CAD severity; SYNTAX score was evaluated as a secondary measure of coronary anatomical complexity. Results: The mean age of the 62 participants was 45.84 ± 7.77 years, 67.7% were male, and the mean SUA concentration was 8.21 ± 1.43 mg/dL. The mean Gensini score was 42.31 ± 18.71, with 50.0% of participants classified descriptively as having severe angiographic disease. SUA concentrations differed significantly across Gensini severity categories (p < 0.001) and were positively correlated with continuous Gensini score (Pearson r = 0.642, p < 0.001; Spearman ρ = 0.626, p < 0.001). SUA was also positively correlated with SYNTAX score (Pearson r = 0.432, p < 0.001; Spearman ρ = 0.422, p = 0.001). In multivariable linear regression, SUA remained significantly associated with Gensini score after adjustment for prespecified clinical and metabolic covariates (B = 8.527, standardized β = 0.654, 95% CI: 5.977–11.076; p < 0.001). The model explained 53.5% of the variance in Gensini score (R² = 0.535; adjusted R² = 0.444), and sensitivity analyses produced comparable estimates. Conclusion: Among diabetic patients presenting with ACS and SUA concentrations >6.0 mg/dL, higher SUA concentration was significantly associated with greater angiographic CAD burden as measured by the Gensini score, with a consistent secondary association observed for SYNTAX score. These findings suggest that SUA may represent a readily measurable adjunctive marker of angiographic coronary disease burden in this selected high-risk population.