title: Prognostic Value of Elevated Homocysteine Levels in Korean Patients with Coronary Artery Disease: A Propensity Score Matched Analysis.
abstract: OBJECTIVE
  We sought to determine whether an elevated homocysteine (Hcy) level is associated with a worse prognosis in Korean patients with coronary artery disease (CAD).
  
  
  METHODS
  A total of 5839 patients (60.4% male, mean age 61.3±11.2 years) with CAD were enrolled from 2000 to 2010 at Gangnam Severance Hospital. CAD was diagnosed by invasive coronary angiography. Laboratory values including Hcy level were obtained on the day of coronary angiography and analyses were performed shortly after sampling. Patients were divided into two groups according to their Hcy levels. Baseline risk factors, coronary angiographic findings, length of follow-up, and composite endpoints including cardiac death (CD) and non-fatal myocardial infarction (NFMI) were recorded. 1:1 propensity score matched analysis was also performed.
  
  
  RESULTS
  Over a mean follow-up period of 4.4±2.5 years, there were 132 composite endpoints (75 CD and 57 NFMI) with an event rate of 2.3%. Mean Hcy level was 9.9±4.3 µmol/L (normal Hcy 7.9±1.5 µmol/L and elevated Hcy 13.9±5.1 µmol/L). Kaplan-Meier survival analysis showed an association of elevated Hcy level with worse prognosis (p<0.0001). In addition, a multivariate Cox regression analysis showed an association of elevated Hcy level with worse prognosis for both the entire cohort (hazard ratio [HR] 2.077, 95% confidence interval [CI] 1.467-2.941, p<0.0001) and the propensity score matched cohort (HR 1.982, 95% CI 1.305-3.009, p=0.001).
  
  
  CONCLUSIONS
  Elevated Hcy level is associated with worse outcomes in Korean patients with CAD.
authors.affiliation: Department of Cardiology, Inha University Hospital, Incheon, Korea.; Department of Medicine, Yonsei University Graduate School, Seoul, Korea.
authors.forename: Sung Woo
authors.initials: SW
authors.lastname: Kwon
authors.affiliation: Department of Cardiology and Cardiovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jong-Youn
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Clinical Research Institute, Inha University School of Medicine, Incheon, Korea.
authors.forename: Young Ju
authors.initials: YJ
authors.lastname: Suh
authors.affiliation: Future Strategy, Inha University Hospital, Incheon, Korea.
authors.forename: Dae Hyung
authors.initials: DH
authors.lastname: Lee
authors.affiliation: Department of Cardiology and Cardiovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Young Won
authors.initials: YW
authors.lastname: Yoon
authors.affiliation: Department of Cardiology and Cardiovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Byoung Kwon
authors.initials: BK
authors.lastname: Lee
authors.affiliation: Department of Cardiology and Cardiovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Jung
authors.affiliation: Department of Cardiology and Cardiovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Eui-Young
authors.initials: EY
authors.lastname: Choi
authors.affiliation: Department of Cardiology and Cardiovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Bum-Kee
authors.initials: BK
authors.lastname: Hong
authors.affiliation: Department of Cardiology and Cardiovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Se-Joong
authors.initials: SJ
authors.lastname: Rim
authors.affiliation: Department of Cardiology and Cardiovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hyuck Moon
authors.initials: HM
authors.lastname: Kwon
keywords: Coronary artery disease; Homocysteine; Prognosis