Impact of Homocysteine Level on Long-term Cardiovascular Outcomes in Patients after Coronary Artery Stenting

Abstract

Aim: The prognostic value of homocysteine (HCY) in patients with coronary artery diseases (CAD) is still controversial. The objective of this study was to investigate whether elevated HCY level at admission predict long-term outcomes in patients after percutaneous coronary interventions (PCI) with coronary artery stenting.Methods: From the institutional registry of Cardiovascular Atherosclerosis and Percutaneous TrAnsluminal INterventions (CAPTAIN), we enrolled a total of 1,307 patients with documented CAD undergone PCI with bare metal stents from July 2003 to December 2014. They were divided into two groups according to the fasting plasma HCY levels before catheterization: group I (883 patients, < 12 µmol/L) and group II (424 patients, ≥ 12 µmol/L). The primary endpoint was occurrence of major adverse cardiac events (MACE), including cardiac death, nonfatal myocardial infarction, stroke, target lesion revascularization, new lesion stenting, and requiring bypass surgery.Results: After a mean follow-up period of 58 ± 41 months, the group II patients had a higher MACE rate (33.3% vs. 25.6%, p = 0.005). The main differences between two groups were cardiac death (8.0% vs. 3.4%, p = 0.001) and new lesion stenting (13.6% vs. 9.5%, p = 0.034). The risks of long-term MACE remained significantly higher in patients with elevated HCY level (≥ 12 µmol/L) after adjusting for clinical variables, with a hazard ratio of 1.29 (95% CI, 1.02–1.64, p = 0.036).Conclusions: Elevated HCY level (≥ 12 µmol/L) was independently associated with increased risk of long-term cardiovascular events in patients after coronary artery bare metal stents implantations. Thus, hyperhomocysteinemia may remain a useful prognostic marker for the risk assessment in clinical care of CAD patients.

Correlation of hyper-homocysteinemia with coronary artery disease in absence of conventional risk factors among young adults

“…Yeh et al [24] showed that plasma homocysteine level was 16.4 + 6.44 µmol/L in patients with myocardial infarction. This study had limited participants and included all those patients who had primary Percutaneous Coronary Intervention (PCI) done with bare metal stent (BMS).…”

Neopterin and Cardiovascular Events Following Coronary Stent Implantation in Patients with Stable Angina Pectoris

“…Several markers were reported regarding the progression of CAD but also restenosis after PCI including in-stent restenosis after stent implantation 17 , 18 ) . To the best of our knowledge, this study is the first to evaluate the relationship between preprocedural plasma neopterin levels and cardiovascular events after coronary stent implantation in patients with SAP and to investigate the immunohistochemical staining for neopterin at the sites following stenting.…”

Hyperhomocysteinemia and Functional State of Endothelium in Patients with Peripheral Artery Disease with Arterial Reconstructions

“…T h e p a t h o g e n e s i s o f t h r o m b o s i s i n hyperhomocysteinemia is not fully understood and, according to the authors, may be multifactorial [11], while hyperhomocysteinemia, promoting activation of the coagulation cascade and increasing hypercoagulable states, is associated with a risk of unfavorable cardiovascular events and the effectiveness of surgical revascularization [12]. The conducted studies confirm the important role of homocysteine in the disturbance of fibrinolytic function of the endothelium and the excessive production of inhibitors of fibrinolysis activation, as indicated by direct correlation between homocysteine and PAI-1 level.…”