[Mild hyperhomocysteinemia, low folate levels and prognosis of acute coronary syndrome without ST elevation].
OBJECTIVE
The influence of homocysteine metabolism on the prognosis of acute coronary syndrome without ST elevation is controversial.


METHODS
Prospective study of 109 patients admitted because of acute coronary syndrome without ST elevation. Basal plasmatic levels of homocysteine and folates were obtained. Clinical features and survival data on follow-up were registered.


RESULTS
Both two years-free-of-events and total survival were lower in patients with low folate levels (36.5% vs 72.5%, p = 0.02; 48% vs 94%, p < .001). Patients with high homocysteine levels had lower two years-free-of-events survival (57.4% vs 89.1%, p < .01); but no difference in the total survival was observed (86.3% vs 97.3%, p = 0.11). The multivariate analysis showed that low folate levels was an independent predictor of mortality (odds ratio [OR] = 8.33; 95% confidence interval [CI], 1.88-33.33; p < 0.01), and moderate high homocysteine was an independent predictor of events on follow-up (OR = 4.34; 95% CI, 1.47-12.50; p < 0.01).


CONCLUSIONS
Patients with high homocysteine or low folate levels have a poor prognosis compared with those with normal levels. On the other hand, low folate levels and moderate hyiperhomocysteinemia are independent predictors of bad prognosis in the follow-up.
García-Pinilla
José M
JM
Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, España. pinilla@secardiologia.es
Espinosa-Caliani
Salvador
S
Gómez-Doblas
Juan J
JJ
Jiménez-Navarro
Manuel F
MF
Cabrera-Bueno
Fernando
F
Muñoz Morán
Encarnación
E
Ruiz-Galdón
Maximiliano
M
Reyes-Engel
Armando
A
de Teresa Galván
Eduardo
E
D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D005494:Folic Acid Deficiency / Q000453:epidemiology*; D006801:Humans; D020138:Hyperhomocysteinemia / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D011379:Prognosis; D012720:Severity of Illness Index