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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

View larger version (21K): [in a new window]   Figure 1 Kaplan-Meier curves for freedom from major adverse cardiac events according to homocysteine quartiles. There is a strong dose-response relationship between homocysteine quartiles and the incidence of major adverse cardiac events, with 92.0% of patients in the first homocysteine quartile free of any cardiac event, 88.6% in the second quartile, 82.2% in the third quartile, and 78.0% in the fourth quartile (p < 0.05), a relative risk increase between extreme quartiles of 2.8 (95% confidence interval = 1.34 to 5.67).

View larger version (34K): [in a new window]   Figure 2 Relative risk of major adverse cardiac events according to homocysteine quartiles among total study population and subgroups of patients stratified according to the traditional cardiovascular risk factors. Squares indicates the relative risk (RR) of major adverse cardiac events for patients in the second, third, and fourth homocysteine quartile compared with patients in the first quartile; size of square is proportional to number of patients; and horizontal line indicates 95% confidence interval (CI); RRs are displayed on logarithmic scale. The strongest RR increase between the first and fourth quartile was found in men, smokers, and hypercholesterolemic patients (RR = 3.00, 95% CI = 1.27 to 7.12; RR = 3.50, 95% CI = 0.73 to 9.62; and RR = 2.45, 95% CI = 1.13 to 5.30, respectively).