Relation of homocysteine levels with patency and flow rate of infarct related artery in patients receiving fibrinolytic therapy

Abstract

Objective: Elevated homocysteine levels induce a hypercoagulable state and make the clot more resistant to fibrinolysis. In this prospective observational study, we investigated the influence of homocysteine levels on infarct-related artery (IRA) patency and flow as determined with regard to thrombolysis in myocardial infraction (TIMI) flow grade and corrected TIMI frame count (CTFC). Methods: Sixty-one patients who received fibrinolytic therapy for a first ST elevation myocardial infarction (STEMI) within 12 hours of chest pain were included. Coronary angiography was performed according to the Judkins technique within 72 hours after fibrinolytic therapy. Total plasma homocysteine level was determined by the high-performance liquid chromatography method with fluorescence detection. Statistical analysis was performed using Chi-square, Student's t and Pearson correlation tests. Logistic regression analysis was used to determine the predictors of IRA occlusion. Results: Of the 61 patients, 22 (36.1%) had an occluded IRA (group 1), 39 (63.9%) had a patent IRA (group 2). Mean plasma homocysteine levels were found to be significantly higher in the group 1 compared to the group 2 (18.5±9.6 μmol/L vs 14.3±5 μmol/L, p=0.04). In addition, we found a significant positive correlation between CTFC and plasma homocysteine levels (r=0.415; p<0.01). In multiple logistic regression analysis, high levels of plasma homocysteine (OR=1.2; 95% CI 1.1-1.25; p=0.03) and being a non-smoker (OR=5.9; 95% CI 1.1-31.6; p=0.03) were found to be significant independent predictors of having an occluded IRA. Conclusion: There is an inverse relation between plasma homocysteine levels and IRA patency and flow in patients receiving fibrinolytic therapy for STEMI. (Anadolu Kardiyol Derg 2010; 10: 410-5) Key words: Homocysteine, fibrinolytic therapy, infarct-related artery, logistic regression analysis ÖZET Amaç: Yüksek homosistein düzeyleri mevcut pıhtıyı fibrinolize daha dirençli hale getirmektedir. Bu prospektif gözlemsel çalışmada, homosistein düzey-lerinin, TIMI (thrombolysis in myocardial infarction) akım derecesi ve TIMI kare sayısına göre değerlendirilen enfarktüs ile ilişkili arter (EİA) açıklık ve akım hızı üzerine etkisini araştırdık. Yöntemler: ST yükselmeli miyokart enfarktüsü nedeniyle, göğüs ağrısının ilk 12 saati içinde fibrinolitik tedavi alan 61 hasta çalışmaya alındı. Fibrinolitik tedavi sonrası 72 saat içinde Judkins tekniği ile koroner anjiyografi yapıldı. Total plazma homosistein düzeyi flörosan saptama ile yüksek performanslı likit kromatografi metodu ile belirlendi. İstatistiksel analiz Ki-kare, Student t test, Pearson korelasyon testi kullanılarak yapıldı. EİA oklüzyonu öngördü-rücülerinin belirlemesinde lojistik regresyon analizi kullanıldı. Bulgular: Çalışmaya alınan 61 hastanın 22'sinde (%36.1) EİA tıkalı (grup 1), 39'unda (%63.9) EİA açık (grup 2) saptandı. Ortalama plazma homosistein düzeyleri grup 1 de grup 2 ile kıyaslandığında daha yüksekti (18.5±9.6 μmol/L'ye karşın 14.3±5 μmol/L, p=0.04). Ayrıca düzeltilmiş...

Elevated plasma homocysteine level is associated with poor ST-segment resolution in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention at high altitude

“…Elevated HCY is associated with mortality as well as serious non-fatal outcomes in patients with unstable angina and non-ST-segment elevation myocardial infarction (NSTEMI) [12] , and increased intracoronary thrombus burden in patients with acute coronary syndrome [13–14] . Previous observational studies in patients with STEMI suggested an association between elevated HCY level with impaired STR after fibrinolytic therapy [13,15] . We conducted a retrospective analysis to examine the potential relationship between elevated serum HCY and poor ST-segment resolution (STR) after PPCI.…”