Background-It has been suggested by clinical, epidemiological, and experimental in vitro studies that homocysteine potentiates thrombin generation. This prothrombotic effect however has not previously been demonstrated in patients presenting with acute coronary syndromes (ACS). Methods and Results-Patients with ACS (n ϭ117) presenting with confirmed acute myocardial infarction (MI) (n ϭ57) or unstable angina pectoris (UAP) (n ϭ60) were consecutively recruited together with patients (n ϭ18) in whom the presenting chest pain was not of cardiac origin (NCP), included as controls. Plasma samples were collected on admission and before clinical intervention. Homocysteine was assayed by high performance liquid chromatography, and both Factor VIIa and prothrombin fragment F1ϩ2 were analyzed by ELISA. There were significant elevations in F1ϩ2 in MI (PϽ0.001) and UAP (Pϭ0.003), and modest elevations in Factor VIIa in UAP (PϽ0.05) compared with NCP but no differences in homocysteine levels among those groups. On dividing patients with ACS into quartiles of homocysteine, there was a stepwise increase in F1ϩ2 (PϽ0.0001) and of Factor VIIa (PϽ0.05). There were significant correlations in ACS between homocysteine and F1ϩ2 (rϭ0.46, PϽ0.0001), homocysteine and Factor VIIa (rϭ0.24, PϽ0.01), and F1ϩ2 and Factor VIIa (rϭ0.41, PϽ0.0001). There was no correlation between homocysteine and either F1ϩ2 (rϭϪ0.15, Pϭ0.57) or Factor VIIa (rϭ0.22, Pϭ0.37) in the NCP patients. Conclusions-Elevated plasma homocysteine is associated with and may cause elevated Factor VIIa and thrombin generation in patients presenting with ACS. These findings suggest an explanation for the prothrombotic effect of homocysteine in ACS.

Patients with anaemia undergoing PPCI are at a higher risk of an adverse outcome. Anaemia is a simple and powerful marker of poor prognosis. Although anaemia (based on the WHO definitions) does not appear to be an independent predictor of all-cause mortality or major adverse cardiac events after PPCI on multivariate analysis, there appears to be a threshold value of Hb among men, below which there is an associated increased risk for PPCI.

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Background Cardiac MR stress perfusion remains a qualitative technique in clinical practice due to technical and postprocessing challenges. However, automated inline perfusion mapping now permits myocardial blood flow (MBF, ml/g/min) quantification on‐the‐fly without user input. Purpose To investigate the diagnostic performance of this novel technique in detecting occlusive coronary artery disease (CAD) in patients scheduled to undergo coronary angiography. Study Type Prospective, observational. Subjects Fifty patients with suspected CAD and 24 healthy volunteers. Field Strength 1.5T. Sequence "Dual" sequence multislice 2D saturation recovery. Assessment All patients underwent cardiac MR with perfusion mapping and invasive coronary angiography; the healthy volunteers had MR with perfusion mapping alone. Statistical Tests Comparison between numerical variables was performed using an independent t‐test. Receiver operator characteristic (ROC) curves were generated for transmyocardial, endocardial stress MBF, and myocardial perfusion reserve (MPR, the stress:rest MBF ratio) to diagnose severe (>70%) stenoses as measured by 3D quantitative coronary angiography (QCA). ROC curves were compared by the method of DeLong et al. Results Compared with volunteers, patients had lower stress MBF and MPR even in vessels with <50% stenosis (2.00 vs. 3.08 ml/g/min, respectively). As stenosis severity increased (<50%, 50–70%, >70%), MBF and MPR decreased. To diagnose occlusive (>70%) CAD, endocardial and transmyocardial stress MBF were superior to MPR (area under the curve 0.92 [95% CI 0.86–0.97] vs. 0.90 [95% CI 0.84–0.95] and 0.80 [95% CI 0.72–0.87], respectively). An endocardial threshold of 1.31 ml/g/min provided a per‐coronary artery sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 90%, 82%, 50%, and 98%, with a per‐patient diagnostic performance of 100%, 66%, 57%, and 100%, respectively. Data Conclusion Perfusion mapping can diagnose occlusive CAD with high accuracy and, in particular, high sensitivity and NPV make it a potential "rule‐out" test. Level of Evidence: 1 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019;50:756–762.