Aim To explore the effect of hyperuricemia on the severity of coronary artery disease and clinical prognosis after percutaneous coronary intervention(PCI)of patients with acute coronary syndrome(ACS)and hypertension.Methods 422 patients were included who were diagnosed with ACS and hypertension after PCI. According to the diagnostic criteria of hyperuricemia, these patients were divided into hyperuricemia group (208 patients) and normal-level serum uric acid (UA) group (214 patients), and the general clinical characteristics, coronary angiography results and major adverse cardiovascular events within 1 year were analyzed. Univariate and multivariate Logistic regression models were used to explore the related risk factors of multi-vessel coronary artery disease and total MACE within 1 year. Furthermore, the serum UA levels of all patients were grouped according to the interquartile range to explore the dose-effect relationship between serum UA levels and total MACE within 1 year, severity of coronary artery disease. Spearman correlation analysis was used to analyze the correlation between serum UA level and Gensini score. With all-cause death as the ending event, Kaplan-Meier survival curve was used to describe the cumulative survival of two groups within 1 year (Log-rank test).Results Compared with normal-level serum uric acid group, multi-vessel coronary artery disease and non-criminal vascular occlusion were more common, and the Gensini scores were also higher in the hyperuricemia group (P＜0.05). Among the MACE that occurred within one year, the incidence of all-cause death, PCI or coronary artery bypass grafting (CABG) for myocardial infarction or angina pectoris, conservative medication treatment for myocardial infarction or angina pectoris, and total MACE were higher (P＜0.05). Univariate and multivariate Logistic regression analysis models showed that hyperuricemia was still an independent risk factor for total MACE within 1 year and multi-vessel coronary artery disease before and after adjusting for confounding factors (P＜0.05). The severity of coronary artery disease and the incidence of total MACE increased significantly with the increase of serum uric acid levels (P＜0.05). And the one-year all-cause death cumulative survival rate of hyperuricemia group decreased significantly(Log-rank test, P＝0.043) compared with patients with normal-level serum uric acid group. Conclusion Hyperuricemia is an independent risk factor for multi-vessel coronary artery disease and total MACE in patients with ACS and hypertension after PCI, and patients with hyperuricemia had a lower survival rate compared with patients with normal-level serum uric acid.