Kobayashi N, et al. - In patients with acute coronary syndrome (ACS), researchers assessed the links between very high levels of serum uric acid (sUA) and optical coherence tomography (OCT)-detected features of culprit lesion plaque morphology, as well as adverse clinical outcomes. Based on the sUA levels of > 8.0 mg/dL (n=169), 7.1–8.0 mg/dL (n=163), 6.1–7.0 mg/dL (n=259), and ≤ 6.0 mg/dL (n=717), retrospective comparisons involving ACS patients were carried out. They also analyzed angiography and OCT findings in patients with preintervention OCT and compared the 4 sUA groups (> 8.0 mg/dL, n=61; 7.1–8.0 mg/dL, n=72; 6.1–7.0 mg/dL, n=131; and ≤ 6.0 mg/dL, n=348). A greater prevalence of cardiogenic shock was found in ACS patients with sUA > 8.0 mg/dL (22% vs 19% vs 10% vs 6%). Those with sUA > 8.0 mg/dL had more prevalence of plaque rupture on OCT. Overall, 2-year cardiac mortality was mainly predicted by very high sUA levels like > 8.0 mg/dL and could, in part, be due to adverse effects of accumulated sUA on plaque morphology.