title: Early determination of homocysteine levels in acute coronary syndromes, is it an independent prognostic factor?
abstract: BACKGROUND
  Increased concentrations of homocysteine (tHcy) are considered a potentially modifiable risk factor for coronary heart disease. The relationship between plasma homocysteine and prognosis has been less well studied. The aim of this study was to examine a possible relationship between the homocysteine levels in admission and all cause mortality in subjects presenting with non-ST segment elevation (NSTE) acute coronary syndrome.
  
  
  METHODS
  We studied 854 patients with suspected NSTE acute coronary syndrome admitted consecutively to our institution, tHcy was determined at a median of 3 days from enrolment and was analyzed in tertiles together with classical risk factors and other biochemical markers. The primary end point was all cause mortality at 1 year follow-up.
  
  
  RESULTS
  There were 86 deaths in the upper 2 tertiles (> or =10.1 mmol/L). The events registered in the lower tertile of admission homocysteine concentration were 12 deaths. Therefore, tHcy values over 10 mumol/l increases the posibility of long term all cause mortality after an NSTE acute coronary syndromes (HR 2.5). This is independent of other prognostic factors as important as age, cardiovascular risk factors, congestive heart failure or creatinine levels at arrival. This is the first study that shows the tHcy prognostic value with independece of the acute phase reactants.
  
  
  CONCLUSIONS
  Determination of plasmatic levels of tHcy in the acute phase of a NSTE acute coronary syndrome is a useful tool in the prognostic stratification, independently of classical risk markers (age, cardiovascular risk factors, heart failure, troponin peak) of acute phase reactants and of creatinine obtained at arrival.
authors.affiliation: Servicio de Cardiología, Hospital Clinico Universitario de Valencia, Spain. lfacila@Hotmail.com
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Fácila
authors.forename: Julio E
authors.initials: JE
authors.lastname: Nuñez
authors.forename: Vicente Bertomeu
authors.initials: VB
authors.lastname: G
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
authors.forename: Vicent
authors.initials: V
authors.lastname: Bodi
authors.forename: Fco J
authors.initials: FJ
authors.lastname: Chorro
authors.forename: Angel
authors.initials: A
authors.lastname: Llacer
authors.forename: Fco J
authors.initials: FJ
authors.lastname: Chorro
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers; D003327:Coronary Disease / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D016014:Linear Models; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D011379:Prognosis; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D006710:Homocysteine