title: Homocysteine and outcome in young patients with acute coronary syndromes.
abstract: BACKGROUND
  Despite the well-known pro-thrombotic and pro-inflammatory plasma homocysteine effects, it remains uncertain whether these effects can be associated with an adverse cardiac outcome in young patients admitted with acute coronary syndromes.
  
  
  METHODS
  Homocysteine levels were determined within 24 h after admission in 244 consecutive patients aged less than 56 years who presented with an acute coronary syndrome. We evaluated the relationship between homocysteine and both short-term (death, myocardial [re]infarction), and long-term prognosis (death, recurrent acute coronary syndrome and/or ischemic stroke), after 3.4+/-1.7 years of follow-up.
  
  
  RESULTS
  Homocysteine levels were similar in patients both with and without in-hospital event: 8.65 (5.36-10.48) vs. 8.98 (7.38-11.13) micromol/l, p=NS. However, patients who presented with the combined event during follow-up had higher homocysteine levels than those free of the event: 10.54 (7.90-11.76) micromol/l vs. 8.52 (7.11-10.23) micromol/l, p=0.001. Patients who either died (13.78 vs. 8.87 micromol/l, p=0.012) or had a myocardial infarction (10.75 vs. 8.76 micromol/l, p=0.006) or unstable angina (10.46 vs. 8.76, p=0.006) during follow-up had higher homocysteine levels. According to the Cox regression analysis: age [hazard ratio 1.05, CI 95%, 0.99-1.10], left ventricular ejection fraction < or =40% [hazard ratio 1.93, CI 95%, 0.98-3.79], and homocysteine tertile 3 [hazard ratio 2.05, CI 95%, 1.13-3.71] were the significant determinants of the combined adverse event during follow-up. Although 41 (18%) of patients presented the TT genotype of the methylen-tetrahydrofolate-reductase thermolabile variant mutation, its occurrence had a neutral effect on morbid-mortality.
  
  
  CONCLUSIONS
  High homocysteine levels at admission strongly predict late cardiac events in young patients with acute coronary syndromes.
authors.affiliation: Cardiology Department, University Hospital, Salamanca, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Martín-Herrero
authors.forename: Javier
authors.initials: J
authors.lastname: Martín-Moreiras
authors.forename: Pedro
authors.initials: P
authors.lastname: Pabón
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Sánchez
authors.forename: José Luis
authors.initials: JL
authors.lastname: Moríñigo-Muñoz
authors.forename: Javier
authors.initials: J
authors.lastname: Jimenez-Candil
authors.forename: Ignacio
authors.initials: I
authors.lastname: Cruz-González
authors.forename: Ignacio
authors.initials: I
authors.lastname: Alberca
authors.forename: José Ramón
authors.initials: JR
authors.lastname: González-Porras
authors.forename: Cándido
authors.initials: C
authors.lastname: Martín-Luengo
mesh_terms: D000367:Age Factors; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D017678:Sex Distribution; D013030:Spain / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology; D016019:Survival Analysis
chemical_list: D006710:Homocysteine