Plasma homocysteine levels and late outcome after coronary angioplasty.
OBJECTIVE
The aim of this study was to evaluate a possible relationship between homocysteine levels on admission and late outcome after successful percutaneous coronary intervention (PCI).


BACKGROUND
Increasing evidence suggests that mild to moderate elevation of total plasma homocysteine is a graded and potentially modifiable risk factor for cardiovascular disease and death that appears to be largely independent of other traditional risk factors.


METHODS
A total of 549 patients were included after successful PCI of at least one coronary stenosis (> or =50%). End points were cardiac death, nonfatal myocardial infarction (MI), target lesion revascularization (TLR), and a composite of major adverse cardiac events (MACE). The relationship between homocysteine levels and study endpoints was assessed.


RESULTS
After a median (+/- SD) follow-up of 58 +/- 20 weeks, 6 patients died of cardiac death, 14 were diagnosed with a new MI, and 71 underwent repeat TLR. A graded relationship between homocysteine levels (quartiles) and freedom from MACE was found (p = 0.01). Homocysteine levels (+/- SD) were associated with cardiac death (14.9 +/- 1.7 micromol/l vs. 9.6 +/- 4.3 micromol/l, p < 0.005), TLR (10.7 +/- 4.4 micromol/l vs. 9.5 +/- 4.3 micromol/l, p < 0.05), and overall MACE (11.0 +/- 4.4 micromol/l vs. 9.4 +/- 4.3 micromol/l, p < 0.005). These findings remained unchanged after adjustment for potential confounders.


CONCLUSIONS
Plasma homocysteine is an independent predictor of mortality, nonfatal MI, TLR, and overall adverse late outcome after successful coronary angioplasty.
Schnyder
Guido
G
Division of Cardiology, Medical Center, University of California at San Diego, 200 West Arbor Drive, San Diego, CA 92103-8784, USA. g.schnyder@lycos.com
Flammer
Yvonne
Y
Roffi
Marco
M
Pin
Riccardo
R
Hess
Otto Martin
OM
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D023921:Coronary Stenosis / Q000097:blood / Q000453:epidemiology / Q000628:therapy; D003404:Creatinine / Q000097:blood; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D008076:Cholesterol, HDL; D006710:Homocysteine; D003404:Creatinine