Acute and convalescent changes in plasma homocysteine concentrations in acute coronary syndromes.
BACKGROUND
Raised plasma homocysteine is a risk factor for coronary artery disease. Patients with myocardial infarction or unstable angina show greater activation of coagulation, greater troponin release, and a worse outcome.


OBJECTIVE
To examine variations in plasma homocysteine concentration in relation to C reactive protein (CRP) in patients presenting with acute coronary syndromes.


METHODS
Consecutive patients presenting with acute myocardial infarction (22) and unstable angina pectoris (12) were studied. Plasma samples were obtained on admission (before clinical intervention), on days 2, 7, and 28, and again six months after admission. Plasma homocysteine, assayed by high performance liquid chromatography, and CRP were both determined at the same time points. Changes were assessed by analysis of variance.


RESULTS
CRP concentrations showed a classical rise on day 2, followed by a gradual decline to normal values taken at six months from admission in both myocardial infarction (p < 0.0001) and unstable angina (p = 0.02). Homocysteine concentrations in myocardial infarction (median, 25th to 75th interquartile range) were: 11.9 (10.7 to 12.6), 11.5 (9.1 to 13.4), 12.1 (11.4 to 14.1), 12.4 (11.1 to 14.4), and 12.1 (11.2 to 14.0) micromol/l, for days 1, 2, 7, 28, and 180, respectively (p = 0.02). Significant differences were observed only between day 2 and day 7 (p < 0.05). The final homocysteine measurement was not different from the admission level. Homocysteine concentrations in unstable angina did not differ between admission and convalescence (12.5 (9.1 to 14.5) micromol/l and 12.3 (7.7 to 14.9) micromol/l, respectively).


CONCLUSIONS
Plasma homocysteine concentrations are minimally influenced by acute phase variations with reliable measurements obtained on admission in patients with myocardial infarction and unstable angina.
National Heart and Lung Institute, Charing Cross Campus, Imperial College School of Medicine, and the Cardiology Department of The Hammersmith Hospitals NHS Trust, London, UK. m.al-obaidi@rbh.nthames.nhs.uk
M K
MK
Al-Obaidi
P J
PJ
Stubbs
R
R
Amersey
M I
MI
Noble
D000208:Acute Disease; D000704:Analysis of Variance; D000789:Angina, Unstable / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism; D003325:Coronary Care Units; D005260:Female; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood*; D010343:Patient Admission; D018709:Statistics, Nonparametric
D006710:Homocysteine; D002097:C-Reactive Protein