open access

Vol 28, No 4 (2021)
Original Article
Published online: 2020-12-01
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Homocysteine and long-term recurrent infarction following an acute coronary syndrome

Gema Miñana, Carolina Gil-Cayuela, Lorenzo Fácila, Vicent Bodi, Ernesto Valero, Anna Mollar, Maria Marco, Teresa García-Ballester, Begoña Zorio, Jorge Martí-Cervera, Eduardo Núñez, Francisco J. Chorro, Juan Sanchis, Julio Núñez
DOI: 10.5603/CJ.a2020.0170
·
Pubmed: 33346372
·
Cardiol J 2021;28(4):598-606.

open access

Vol 28, No 4 (2021)
Original articles — Clinical cardiology
Published online: 2020-12-01

Abstract

Background: There are no well-established predictors of recurrent ischemic coronary events after an acute coronary syndrome (ACS). Higher levels of homocysteine have been reported to be associated with an increased atherosclerotic burden. The primary endpoint was to assess the relationship between homocysteine at discharge and very long-term recurrent myocardial infarction (MI).
Methods: 1306 consecutive patients with ACS were evaluated (862 with non-ST-segment elevation ACS [NSTEACS] and 444 with ST-segment elevation myocardial infarction [STEMI]) discharged from October 2000 to June 2003 in a single teaching-center. The relationship between homocysteine at discharge and recurrent MI was evaluated through bivariate negative binomial regression accounting for mortality as a competitive event.
Results: The mean age was 66.8 ± 12.4 years, 69.1% were men, and 32.2% showed prior diabetes mellitus. Most of the patients were admitted for an NSTEACS (66.0%). The median (interquartile range) GRACE risk score, Charlson comorbidity index, and homocysteine were 144 (122–175) points, 1 (1–2) points, and 11.9 (9.3–15.6) μmol/L, respectively. In-hospital revascularization was performed in 26.3% of patients. At a median follow-up of 9.7 (4.5–15.1) years, 709 (54.3%) deaths were registered and 779 recurrent MI in 478 (36.6%) patients. The rates of recurrent MI were higher in patients in the upper homocysteine quartiles (p < 0.001). After a multivariate adjustment, homocysteine along its continuum remained almost linearly associated with a higher risk of recurrent MI (p = 0.001) and all-cause mortality (p < 0.001).
Conclusions: In patients with ACS, higher homocysteine levels identified those at a higher risk of recurrent MI at very long-term follow-up.

Abstract

Background: There are no well-established predictors of recurrent ischemic coronary events after an acute coronary syndrome (ACS). Higher levels of homocysteine have been reported to be associated with an increased atherosclerotic burden. The primary endpoint was to assess the relationship between homocysteine at discharge and very long-term recurrent myocardial infarction (MI).
Methods: 1306 consecutive patients with ACS were evaluated (862 with non-ST-segment elevation ACS [NSTEACS] and 444 with ST-segment elevation myocardial infarction [STEMI]) discharged from October 2000 to June 2003 in a single teaching-center. The relationship between homocysteine at discharge and recurrent MI was evaluated through bivariate negative binomial regression accounting for mortality as a competitive event.
Results: The mean age was 66.8 ± 12.4 years, 69.1% were men, and 32.2% showed prior diabetes mellitus. Most of the patients were admitted for an NSTEACS (66.0%). The median (interquartile range) GRACE risk score, Charlson comorbidity index, and homocysteine were 144 (122–175) points, 1 (1–2) points, and 11.9 (9.3–15.6) μmol/L, respectively. In-hospital revascularization was performed in 26.3% of patients. At a median follow-up of 9.7 (4.5–15.1) years, 709 (54.3%) deaths were registered and 779 recurrent MI in 478 (36.6%) patients. The rates of recurrent MI were higher in patients in the upper homocysteine quartiles (p < 0.001). After a multivariate adjustment, homocysteine along its continuum remained almost linearly associated with a higher risk of recurrent MI (p = 0.001) and all-cause mortality (p < 0.001).
Conclusions: In patients with ACS, higher homocysteine levels identified those at a higher risk of recurrent MI at very long-term follow-up.

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Keywords

homocysteine, acute coronary syndrome, recurrent myocardial infarction, coronary artery disease, risk factors

Supp./Additional Files (4)
Supplementary Table 1. Baseline characteristics among patients with and without homocysteine assessment.
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Supplementary Figure 1. Flow chart
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Supplementary Figure 2. Functional form of the risk of recurrent MI along the continuum of homocysteine. Subgroup analysis. S2a. Age; S2b. Gender; S2c. Diabetes; S2d. History of ischemic heart disease
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Supplementary Figure 3. Functional form of the risk of recurrent MI along the continuum of homocysteine. Subgroup analysis. S3a. Type of acute coronary syndrome (STEMI vs. SNTEACS); S3b. Charlson index; S3c. GRACE
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About this article
Title

Homocysteine and long-term recurrent infarction following an acute coronary syndrome

Journal

Cardiology Journal

Issue

Vol 28, No 4 (2021)

Article type

Original Article

Pages

598-606

Published online

2020-12-01

DOI

10.5603/CJ.a2020.0170

Pubmed

33346372

Bibliographic record

Cardiol J 2021;28(4):598-606.

Keywords

homocysteine
acute coronary syndrome
recurrent myocardial infarction
coronary artery disease
risk factors

Authors

Gema Miñana
Carolina Gil-Cayuela
Lorenzo Fácila
Vicent Bodi
Ernesto Valero
Anna Mollar
Maria Marco
Teresa García-Ballester
Begoña Zorio
Jorge Martí-Cervera
Eduardo Núñez
Francisco J. Chorro
Juan Sanchis
Julio Núñez

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