Background Large epidemiological studies have demonstrated a significant association between hyperuricemia and an increased risk of coronary artery disease (CAD). Elevated serum uric acid levels are thought to contribute to endothelial dysfunction, oxidative stress, and inflammation, which may influence the severity of coronary atherosclerosis. Aims The present study aimed to evaluate the relationship between serum uric acid levels and the severity of coronary artery disease, as assessed by the Gensini score, in patients presenting with acute coronary syndrome (ACS). Methods This retrospective cohort study was conducted among patients presenting with acute coronary syndrome at a tertiary care center, Sree Mookambika Institute of Medical Sciences. The study duration extended from May 2023 to December 2024. Hyperuricemia was defined as a serum uric acid level greater than 6 mg/dL. All patients underwent coronary angiography, and the severity of coronary artery disease was assessed using the Gensini scoring system. Angiographic parameters including the number of diseased vessels, presence of critical lesions, total occlusions, and left main coronary artery involvement were analyzed. Results The mean serum uric acid levels in the normouricemic and hyperuricemic groups were 4.7 ± 1.1 mg/dL and 7.53 ± 1.32 mg/dL, respectively, with a statistically significant difference (p = 0.001). The mean Gensini score was significantly higher in the hyperuricemic group (35.53 ± 17.84) compared to the normouricemic group (20.56 ± 13.66). Independent t-test and chi-square test analysis demonstrated a statistically significant difference between the two groups (p = 0.001). Spearman correlation analysis revealed a significant positive correlation between serum uric acid levels and Gensini score. Furthermore, the hyperuricemic group exhibited a higher prevalence of total coronary occlusions (p = 0.001) and left main coronary artery stenosis (p = 0.001) compared to the normouricemic group. Conclusion Hyperuricemia is significantly associated with higher Gensini scores, increased frequency of total coronary occlusions, and greater involvement of the left main coronary artery. Serum uric acid appears to be an independent marker for assessing the extent and severity of coronary artery disease in patients presenting with acute coronary syndrome.

Hyperuricemia; Coronary artery disease; Serum uric acid; Gensini score; Acute coronary syndrome