title: Restenosis in Intervened Coronaries with Hyperhomocysteinemia (RICH).
abstract: BACKGROUND
  Controversy exists regarding the contribution made by elevated serum homocysteine evels in raising the risk of restenosis after percutaneous coronary interventions. The objective of this study was to determine whether elevated homocysteine evels increase the risk of restenosis.
  
  
  METHODS
  Two hundred and two consecutive patients undergoing percutaneous coronary intervention with stents on previously nonintervened native coronary arteries were eligible for enrollment in the study. Before the percutaneous coronary intervention, a fasting serum homocysteine evel was drawn. Patients were followed-up by their primary cardiologists for recurrence of symptoms. Those patients who had a recurrence of anginal symptoms consistent with clinical restenosis were referred for a repeat angiogram. All other patients were followed-up medically. The homocysteine evels of the patients who had repeat angiography for recurrent symptoms were compared to those who were followed-up medically.
  
  
  RESULTS
  Age, stent ength, stent diameter, and homocysteine evels were all associated with an increased risk of restenosis in the univariate analysis. In the multiple ogistic regression model, the only variable that remained significant in relation to an increased risk of restenosis was homocysteine. There was a significant difference in the mean homocysteine evels between the restenosis group (13.7 micromol/L) and those without restenosis (9.6 micromol/L; P <.0001). A homocysteine evel > or =11.1 micromol/L was identified as the best threshold for an increased risk of restenosis with a sensitivity of 75.0% and specificity of 76.9% (OR 6.5, CI 2.3-18.6; P =.0004).
  
  
  CONCLUSIONS
  This study demonstrates that elevated homocysteine evels strongly correlate with an increased risk of restenosis.
authors.affiliation: Department of Internal Medicine, Section of Cardiology, and the Cardiac Catheterization aboratory, Kaiser Permanente Medical Center, Los Angeles, Calif, USA.
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Kojoglanian
authors.forename: Michael B
authors.initials: MB
authors.lastname: Jorgensen
authors.forename: Girma
authors.initials: G
authors.lastname: Wolde-Tsadik
authors.forename: Raoul J
authors.initials: RJ
authors.lastname: Burchette
authors.forename: Vicken J
authors.initials: VJ
authors.lastname: Aharonian
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology*; D023921:Coronary Stenosis / Q000628:therapy; D005260:Female; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D020138:Hyperhomocysteinemia / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012044:Regression Analysis; D015607:Stents
chemical_list: D006710:Homocysteine