Admission homocysteine is an independent predictor of spontaneous reperfusion and early infarct-related artery patency before primary percutaneous coronary intervention in ST-segment elevation myocardial infarction

Abstract

BackgroundSpontaneous reperfusion (SR) and early infarct related artery (IRA) patency before primary percutaneous coronary intervention (PPCI) might bring extra benefit for patients with ST-segment elevation myocardial infarction (STEMI). This study premilinarily screened the independent predictors of SR, and assessed the relationship between SR and plasma homocysteine (HCY).MethodsThe medical records of 998 patients who were diagnosed as STEMI and underwent emergency coronary angiography were retrospectively studied, SR was defined as achievement of TIMI grade 3 flow in the IRA before PCI. The baseline characteristics, clinical manifestations and hematological variables were compared between SR and NSR group. Optimal cutoff point of HCY was calculated with receiving operating characteristics (ROC) analysis, multivariate logistic regression models were used to identify predictors of SR.Results229 (22.95%) patients showed angiographic SR. For HCY, the area under the curve was 0.70 (95% CI: 0.63–0.77, P = 0.034), the optimized cut off point was 17.55 μmol/L. Preinfarct angina (95% CI: 1.61–5.65, P = 0.0005), plasma C-reactive protein (CRP) level (95% CI: 0.87–0.99, P = 0.016) and HCY < 17.55 μmol/L (95% CI: 2.43–8.72, P < 0.0001) were found to be independent predictors for SR.ConclusionIn patients with STEMI, HCY < 17.55 μmol/L, preinfarct angina and plasma CRP level were independent predictors of SR.

​Circulating Cytokines in Myocardial Infarction Are Associated With Coronary Blood Flow

“…Despite the fact that certain determinants of the patency of the IRA are well-known (younger age, the absence of significant concomitant diseases, a lower contents of lipoprotein (a), total cholesterol, homocysteine, etc. ), the exact mechanism of blood flow preservation through the IRA remains unclear (6)(7)(8)(9)(10).…”

Relationship Between Plasma Total Homocysteine Levels and Mean Corrected TIMI Frame Count in Patients with Acute Myocardial Infarction

“…In addition, HHcy was a potential predictor for SCF prognosis and related to cumulative cardiac events. 14 Moreover, Li et al 17 observed that increased plasma tHcy levels (≥17.55 μmol/L) were independent negative predictor of spontaneous reperfusion (defined as achievement of TIMI grade III flow in the infarct-related artery (IRA) before primary PCI) in patients with AMI, implying the potential relationship between HHcy with less early IRA patency. However, to our knowledge, there is no detailed study evaluating the relationship between plasma tHcy levels and SCF measured by mean CTFC in patients with AMI.…”

Frequency of Thrombolysis in Myocardial Infarction III Flow in Patients With Primary Percutaneous Coronary Intervention: Not All Culprit Vessels Are Completely Occluded in ST Elevation Myocardial Infarction

“…It was found in this study that symptom onset to hospital arrival time has an effect on the pre-pPCI TIMI flow rate; those patients who came to the hospital earlier have a higher rate of TIMI III flow rate as compared to later comers. The relationship between the late arrival to hospital and TIMI III flow was proven by other studies; it was found that if total ischemic time is higher then there is less chance of TIMI III flow rate in STEMI patients [ 26 , 27 ].…”