Association of plasma homocysteine with restenosis after percutaneous coronary angioplasty.
OBJECTIVE
Restenosis after percutaneous coronary angioplasty remains an important limitation of this procedure. This study evaluates whether elevated total plasma homocysteine levels contribute to the development of restenosis after coronary angioplasty.


RESULTS
Two hundred and five patients were recruited after successful angioplasty of at least one coronary stenosis (> or =50%). End-points were restenosis (> or =50%) and a composite of major adverse cardiac events. Of the 205 patients, 183 (89.3%) underwent 6 months angiographic follow-up. Patients with restenosis had significantly higher homocysteine levels than those without (10.9+/- 3.9 micromol x l(-1) vs 9.3+/-3.8 micromol x l(-1), P<0.01). Homocysteine levels were significantly correlated to follow-up diameter stenosis (r=0.24, P=0.0001), especially in small vessels (<3 mm) treated with balloon angioplasty only (r=0.40, P<0.0005). Late lumen loss at follow-up was significantly smaller with homocysteine levels below 9 micromol x l(-1) (0.62+/-0.82 mm vs 0.90+/-0.77 mm, P<0.01). Restenosis rate (25.3% vs 50.0%, P<0.001) and major adverse cardiac events (15.7% vs 28.4%, P<0.05) were also significantly lower in patients with homocysteine levels below 9 micromol x l(-1). Multivariate analysis did not weaken these findings.


CONCLUSIONS
Total plasma homocysteine is a strong predictor of restenosis and major adverse cardiac events after coronary angioplasty. Thus, plasma homocysteine appears to be an important cardiovascular risk factor influencing outcome after successful coronary angioplasty.
Schnyder
G
G
Division of Cardiology, Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland.
Roffi
M
M
Flammer
Y
Y
Pin
R
R
Hess
O M
OM
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000097:blood* / Q000209:etiology* / Q000401:mortality; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy; D003331:Coronary Vessels / Q000601:surgery; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology / Q000401:mortality; D011446:Prospective Studies; D012008:Recurrence; D012720:Severity of Illness Index; D013223:Statistics as Topic; D016019:Survival Analysis; D016896:Treatment Outcome
D015415:Biomarkers; D006710:Homocysteine