Impact of Homocysteine Level on Long-term Cardiovascular Outcomes in Patients after Coronary Artery Stenting.
OBJECTIVE
The prognostic value of homocysteine (HCY) in patients with coronary artery diseases (CAD) is still controversial. The objective of this study was to investigate whether elevated HCY level at admission predict long-term outcomes in patients after percutaneous coronary interventions (PCI) with coronary artery stenting.


METHODS
From the institutional registry of Cardiovascular Atherosclerosis and Percutaneous TrAnsluminal INterventions (CAPTAIN), we enrolled a total of 1,307 patients with documented CAD undergone PCI with bare metal stents from July 2003 to December 2014. They were divided into two groups according to the fasting plasma HCY levels before catheterization: group Ⅰ (883 patients, ＜12 µmol/L) and group II (424 patients, ≥12 µmol/L). The primary endpoint was occurrence of major adverse cardiac events (MACE), including cardiac death, nonfatal myocardial infarction, stroke, target lesion revascularization, new lesion stenting, and requiring bypass surgery.


RESULTS
After a mean follow-up period of 58±41 months, the group II patients had a higher MACE rate (33.3% vs. 25.6%, p=0.005). The main differences between two groups were cardiac death (8.0% vs. 3.4%, p=0.001) and new lesion stenting (13.6% vs. 9.5%, p=0.034). The risks of long-term MACE remained significantly higher in patients with elevated HCY level (≥12 µmol/L) after adjusting for clinical variables, with a hazard ratio of 1.29 (95% CI, 1.02-1.64, p=0.036).


CONCLUSIONS
Elevated HCY level (≥12 µmol/L) was independently associated with increased risk of long-term cardiovascular events in patients after coronary artery bare metal stents implantations. Thus, hyperhomocysteinemia may remain a useful prognostic marker for the risk assessment in clinical care of CAD patients.
Department of Cardiology, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital.
Jih-Kai
JK
Yeh
Department of Cardiology, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital.
Chun-Chi
CC
Chen
Department of Cardiology, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital.
Ming-Jer
MJ
Hsieh
Department of Cardiology, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital.
Ming-Lung
ML
Tsai
Department of Cardiology, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital.
Chia-Hung
CH
Yang
Department of Cardiology, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital.
Dong-Yi
DY
Chen
Department of Cardiology, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital.
Shang-Hung
SH
Chang
Department of Cardiology, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital.
Chao-Yung
CY
Wang
Department of Cardiology, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital.
Cheng-Hung
CH
Lee
Department of Cardiology, Percutaneous Coronary Intervention Center, Chang Gung Memorial Hospital.
I-Chang
IC
Hsieh
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015607:Stents / Q000009:adverse effects*; D015996:Survival Rate; D055815:Young Adult
D015415:Biomarkers; D006710:Homocysteine
Clinical outcome; Coronary artery stent; Homocysteine