Uric acid (UA) is the final product of the catabolism of endogenous and exogenous purine nucleotides. While its association with articular gout and kidney disease has been known for a long time, new data have demonstrated that UA is also related to cardiovascular (CV) diseases. UA has been identified as a significant determinant of many different outcomes, such as all-cause and CV mortality, and also of CV events (mainly Acute Coronary Syndromes (ACS) and even strokes). Furthermore, UA has been related to the development of Heart Failure, and to a higher mortality in decompensated patients, as well as to the onset of atrial fibrillation. After a brief introduction on the general role of UA in CV disorders, this review will be focused on UA’s relationship with CV outcomes, as well as on the specific features of patients with ACS and Chronic Coronary Syndrome. Finally, two issues which remain open will be discussed: the first is about the identification of a CV UA cut-off value, while the second concerns the possibility that the pharmacological reduction of UA is able to lower the incidence of CV events.

(1) Background: Among the different cardiovascular (CV) manifestations of the coronavirus disease 2019 (COVID-19), arrhythmia and atrial fibrillation (AF) in particular have recently received special attention. The aims of our study were to estimate the incidence of AF in patients hospitalized for COVID-19, and to evaluate its role as a possible predictor of in-hospital all-cause mortality. (2) Methods: We enrolled 3435 people with SARS-CoV2 infection admitted to three hospitals in Northern Italy from February 2020 to May 2021. We collected data on their clinical history, laboratory tests, pharmacological treatment and intensive care unit (ICU) admission. Incident AF and all-cause in-hospital mortality were considered as outcomes. (3) Results: 145 (4.2%) patients developed AF during hospitalization, with a median time since admission of 3 days (I-III quartile: 0, 12). Patients with incident AF were admitted more frequently to the ICU (39.3 vs. 12.4%, p < 0.001), and more frequently died (37.2 vs. 16.9%, p < 0.001). In the Cox regression model, the significant determinants of incident AF were age (HR: 1.041; 95% CI: 1.022, 1.060 per year), a history of AF (HR: 2.720; 95% CI: 1.508, 4.907), lymphocyte count (HR: 0.584; 95% CI: 0.384, 0.888 per 10³/µL), estimated glomerular filtration rate (eGFR, HR: 0.988; 95% CI: 0.980, 0.996 per mL/min) and ICU admission (HR: 5.311; 95% CI: 3.397, 8.302). Incident AF was a predictor of all-cause mortality (HR: 1.405; 95% CI: 1.027, 1.992) along with age (HR: 1.057; 95% CI: 1.047, 1.067), male gender (HR: 1.315; 95% CI: 1.064; 1.626), dementia (HR: 1.373; 95% CI: 1.045, 1.803), lower platelet (HR: 0.997; 95% CI: 0.996, 0.998 per 10³/µL) and lymphocyte counts (HR: 0.843; 95% CI: 0.725, 0.982 per 10³/µL), C-Reactive protein values (HR: 1.004; 95% CI: 1.003, 1.005 per mg/L), eGFR (HR: 0.990; 95% CI: 0.986, 0.994 per mL/min), and ICU admission (HR: 1.759; 95% CI: 1.292, 2.395). (4) Conclusions: Incident AF is a common complication in COVID-19 patients during hospitalization, and its occurrence strongly predicts in-hospital mortality.

Introduction: Peri-procedural myocardial infarction (PMI) after cardiac surgery is a significant yet often under-recognised complication, sometimes necessitating urgent coronary angiography (PMI-rCA). This meta-analysis evaluates its prevalence, angiographic findings, management strategies, and associated mortality. Methods: A systematic review and meta-analysis were conducted according to PRISMA guidelines. Data from nine studies comprising 104,445 post-cardiac surgery patients were analysed. Among them, those undergoing PMI-rCA were categorised by treatment strategy: conservative management, percutaneous coronary intervention (PCI), or reperform surgery. A network meta-analysis compared mortality risks across these groups, with findings visualised using forest plots, network diagrams, and SUCRA rankings. Results: PMI-rCA was performed in 1205 patients (2%). Of these, 34.3% had no significant angiographic abnormalities, 53.7% exhibited graft failure, and 10.4% had native vessel ischemia. Management strategies included conservative treatment (55.5%), PCI (23.5%), and reperforming surgery (21%). Network meta-analysis indicated that conservative management was associated with the lowest mortality risk, followed by PCI, while reperforming surgery had the highest risk. Discussion: These findings highlight the complexity of PMI diagnosis and treatment. The high proportion of patients without significant angiographic abnormalities raises concerns about potential overuse of invasive procedures. Meanwhile, PCI appears to be a more favourable interventional strategy than reperforming surgery in terms of mortality outcomes. Conclusions: PMI requiring coronary angiography is uncommon but clinically significant, with a 16% mortality rate. A tailored, risk-based approach is essential to optimise management, balancing conservative therapy, PCI, and reperforming surgery based on individual patient profiles.