Relationship between serum homocysteine levels and long-term outcomes in patients with ST-segment elevation myocardial infarction
10.1097/CM9.0000000000000159
- Author:
Jin SI
1
;
Xue-Wen LI
2
,
3
;
Yang WANG
4
;
Ying-Hua ZHANG
1
;
Qing-Qing WU
5
;
Lei-Min ZHANG
6
;
Xue-Bing ZUO
1
;
Jing GAO
1
;
Jing LI
1
Author Information
1. Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
2. Department of Cardiology, Tianjin Medical University, Tianjin 300070, China
3. Cadre’s Ward, Characteristic Medical Center of Chinese People’s Armed Police Force, Tianjin 300162, China
4. Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
5. Department of Cardiology, Beijing Luhe Hospital, Capital Medical University, Beijing 101149, China
6. Department of Cardiology, Qinghe Substation Hospital of Beijing Municipal Administration of Prisons, Tianjin 300481, China
- Publication Type:Journal Article
- Keywords:
Homocysteine;
Acute ST-segment elevation myocardial infarction;
Percutaneous coronary intervention;
Clinical outcome
- From:
Chinese Medical Journal
2019;132(9):1028-1036
- CountryChina
- Language:English
-
Abstract:
Background::The mortality of cardiovascular disease is constantly rising, and novel biomarkers help us predict residual risk. This study aimed to evaluate the predictive value of serum homocysteine (HCY) levels on prognosis in patients with ST-segment elevation myocardial infarction (STEMI).
Methods::The 419 consecutive patients with STEMI, treated at one medical center, from March 2010 to December 2015 were retrospectively investigated. Peripheral blood samples were obtained within 24 h of admission and HCY concentrations were measured using an enzymatic cycling assay. The patients were divided into high HCY level (H-HCY) and low HCY level (L-HCY) groups. Short- and long-term outcomes were compared, as were age-based subgroups (patients aged 60 years and younger vs. those older than 60 years). Statistical analyses were mainly conducted by Student t-test, Chi-squared test, logistic regression, and Cox proportional-hazards regression.
Results::The H-HCY group had more males (84.6% vs. 75.4%, P=0.018), and a lower prevalence of diabetes (20.2% vs. 35.5%, P < 0.001), compared with the L-HCY group. During hospitalization, there were seven mortalities in the L-HCY group and 10 in the H-HCY group (3.3% vs. 4.8%, P= 0.440). During the median follow-up period of 35.8 (26.9–46.1) months, 33 (16.2%) patients in the L-HCY group and 48 (24.2%) in the H-HCY group experienced major adverse cardiovascular and cerebrovascular events (MACCE) (P=0.120). History of hypertension (hazard ratio [HR]: 1.881, 95% confidence interval [CI]: 1.178–3.005, P=0.008) and higher Killip class (HR: 1.923, 95% CI: 1.419–2.607, P < 0.001), but not HCY levels (HR: 1.007, 95% CI: 0.987–1.027, P=0.507), were significantly associated with long-term outcomes. However, the subgroup analysis indicated that in older patients, HCY levels were significantly associated with long-term outcomes (HR: 1.036, 95% CI: 1.011–1.062, P=0.005).
Conclusion::Serum HCY levels did not independently predict in-hospital or long-term outcomes in patients with STEMI; however, among elderly patients with STEMI, this study revealed a risk profile for late outcomes that incorporated HCY level.
