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CLINICAL STUDY: CHRONIC CORONARY ARTERY DISEASE

Plasma homocysteine levels and late outcome after coronary angioplasty

Guido Schnyder, MD^,*, Yvonne Flammer, MD^*, Marco Roffi, MD, Riccardo Pin, MD^* and Otto Martin Hess, MD^*

^* Division of Cardiology, Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland
Department of Cardiovascular Medicine/F25, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Division of Cardiology, University of California at San Diego Medical Center, University of California, San Diego, California, USA

Manuscript received March 21, 2002; revised manuscript received June 24, 2002, accepted July 12, 2002.

^* Reprint requests and correspondence: Dr. Guido Schnyder, University of California at San Diego Medical Center, Cardiology Division, 200 West Arbor Drive, San Diego, California, 92103-8784, USA.
g.schnyder{at}lycos.com

OBJECTIVES: The aim of this study was to evaluate a possible relationship between homocysteine levels on admission and late outcome after successful percutaneous coronary intervention (PCI).

BACKGROUND: Increasing 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.

METHODS: A 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.

RESULTS: After 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.

CONCLUSIONS: Plasma homocysteine is an independent predictor of mortality, nonfatal MI, TLR, and overall adverse late outcome after successful coronary angioplasty.

Abbreviations and Acronyms   CI   confidence interval   HDL   high-density lipoprotein   LDL   low-density lipoprotein   MACE   major adverse cardiac events   MI   myocardial infarction   PCI   percutaneous coronary intervention   RR   relative risk   TLR   target lesion revascularization

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