To examine whether serum urate level and other aspects of gouty arthritis are independently associated with Q-wave myocardial infarction (QWMI) in gouty population, we performed a cross-sectional study. A total of 22,572 gouty cases were enrolled. QWMI was defined as a positive finding by resting electrocardiographic criteria excluding the conditions producing pseudoinfarction. The variables of gout were tested univariately and multivariately, controlling for the covariates by logistic regression analysis. The above analysis was then repeated in subgroups of young-aged (<50 years), old-aged (> or = 50 years), male, and female patients. Increased serum urate level was significantly associated with QWMI in all subjects and male subgroup [odds ratio (OR), 1.120; 95% confidence interval (CI), 1.020-1.229; OR, 1.106; 95% CI, 1.001-1.223, respectively, for each mg/dl increment]. After controlling for serum urate level and the covariates, increased affected joint count was also independently associated with QWMI finding in all subjects, male and old-aged subgroups (OR, 1.098; 95% CI, 1.014-1.189; OR, 1.094; 95% CI, 1.005-1.192; OR, 1.095; 95% CI, 1.001-1.199, respectively). Tophi formation was independently associated with QWMI in young-aged subgroup (OR, 2.494; 95% CI, 1.159-5.366). None of the variables of gout including hyperuricemia was significantly associated with QWMI in female subgroup after controlling for covariates. This study first demonstrates that gout is associated with QWMI by both the severity of gouty arthritis and serum urate level, while the association of urate to QWMI could be different between age strata and genders.