Plasma homocysteine levels and late outcome after coronary angioplasty

Abstract

ObjectivesThe aim of this study was to evaluate a possible relationship between homocysteine levels on admission and late outcome after successful percutaneous coronary intervention (PCI). BackgroundIncreasing evidence suggests that mild to moderate elevation of total plasma homocysteine is a graded and potentially modifiable risk factor for cardiovascular disease and death that appears to be largely independent of other traditional risk factors. MethodsA total of 549 patients were included after successful PCI of at least one coronary stenosis (≥50%). End points were cardiac death, nonfatal myocardial infarction (MI), target lesion revascularization (TLR), and a composite of major adverse cardiac events (MACE). The relationship between homocysteine levels and study endpoints was assessed. ResultsAfter a median (± SD) follow-up of 58 ± 20 weeks, 6 patients died of cardiac death, 14 were diagnosed with a new MI, and 71 underwent repeat TLR. A graded relationship between homocysteine levels (quartiles) and freedom from MACE was found (p = 0.01). Homocysteine levels (± SD) were associated with cardiac death (14.9 ± 1.7 μmol/l vs. 9.6 ± 4.3 μmol/l, p < 0.005), TLR (10.7 ± 4.4 μmol/l vs. 9.5 ± 4.3 μmol/l, p < 0.05), and overall MACE (11.0 ± 4.4 μmol/l vs. 9.4 ± 4.3 μmol/l, p < 0.005). These findings remained unchanged after adjustment for potential confounders. ConclusionsPlasma homocysteine is an independent predictor of mortality, nonfatal MI, TLR, and overall adverse late outcome after successful coronary angioplasty.