title: Hyperhomocysteinemia is an independent predictor of long-term clinical outcomes in Chinese octogenarians with acute coronary syndrome.
abstract: OBJECTIVE
  To evaluate the prognostic value of homocysteine (Hcy) in Chinese acute coronary syndrome (ACS) octogenarians.
  
  
  METHODS
  The study cohort comprised 660 consecutive ACS octogenarians who underwent coronary angiography. We classified the patients into three groups according to Hcy tertiles. Kaplan-Meier method was performed for survival and major adverse cardiac events (MACE) rates. Multivariate Cox regression was performed to identify mortality predictors. Receiver operating characteristic curve analysis was performed to predict the cutoff value of Hcy for all-cause mortality.
  
  
  RESULTS
  The follow-up period was 28 (inter-quartile range: 16-38) months. Diastolic blood pressure, ratios of male, renal failure and old myocardial infarction in high plasma level Hcy (H-Hcy) group were higher than those in low (L-Hcy) and middle (M-Hcy) plasma level of Hcy groups (P<0.05). The Hcy level was positively correlated with uric acid level (r=0.211, P=0.001) and Cystatin C (Cys C) level (r=0.212, P=0.001) and negatively correlated with estimated glomerular filtration rate (r=-0.148, P=0.018). For the long-term outcomes, the cumulative survival rate of H-Hcy group was significantly lower than that of L-Hcy and M-Hcy groups (P=0.006). All-cause mortality and MACE of H-Hcy group were higher than those of L-Hcy and M-Hcy group (P=0.0001, P=0.0008). Hcy is an independent predictor for long-term all-cause mortality (odds ratio =2.26, 95% CI=1.23-4.16, P=0.023) and MACE (odds ratio =1.91, 95% CI=1.03-3.51, P=0.039). Receiver operating characteristic curve analysis indicated the predictive cutoff value of Hcy for all-cause mortality was 17.67 μmol/L (0.667, 0.681).
  
  
  CONCLUSIONS
  In ACS octogenarians, hyperhomocysteinemia is an important predictor for long-term all-cause mortality and MACE.
authors.affiliation: Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, People's Republicof China.
authors.forename: Zhenhong
authors.initials: Z
authors.lastname: Fu
authors.affiliation: Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, People's Republicof China.
authors.forename: Geng
authors.initials: G
authors.lastname: Qian
authors.affiliation: Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, People's Republicof China.
authors.forename: Hao
authors.initials: H
authors.lastname: Xue
authors.affiliation: Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, People's Republicof China.
authors.forename: Jun
authors.initials: J
authors.lastname: Guo
authors.affiliation: Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, People's Republicof China.
authors.forename: Lian
authors.initials: L
authors.lastname: Chen
authors.affiliation: Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, People's Republicof China.
authors.forename: Xia
authors.initials: X
authors.lastname: Yang
authors.affiliation: Department of Cardiology, Hainai Branch of Chinese People's Liberation Army General Hospital, Sanya, Hainan, People's Republic of China.
authors.forename: Mingzhi
authors.initials: M
authors.lastname: Shen
authors.affiliation: Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, People's Republicof China.
authors.forename: Wei
authors.initials: W
authors.lastname: Dong
authors.affiliation: Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, People's Republicof China.
authors.forename: Yundai
authors.initials: Y
authors.lastname: Chen
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality; D000369:Aged, 80 and over; D001794:Blood Pressure; D002681:China / Q000453:epidemiology; D017023:Coronary Angiography; D055316:Cystatin C / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D020138:Hyperhomocysteinemia / Q000453:epidemiology*; D053208:Kaplan-Meier Estimate; D008055:Lipids / Q000097:blood; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology; D011379:Prognosis; D012372:ROC Curve; D012044:Regression Analysis; D051437:Renal Insufficiency / Q000453:epidemiology; D012307:Risk Factors; D012737:Sex Factors; D014527:Uric Acid / Q000097:blood
chemical_list: D055316:Cystatin C; D008055:Lipids; D014527:Uric Acid
keywords: acute coronary syndrome; clinical risk factors; homocysteine; octogenarian; outcomes