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Hyperhomocysteinaemia and adverse events complicating coronary catheter interventions
K Stangl1, I Cascorbi, V Stangl
1Humboldt-Universität, Medizinische Klinik, Charité, Campus Mitte, Schwerpunkt Kardiologie, Angiologie, Pneumologie, Schumannstrasse 20/21, D-10117, Berlin, Germany. karl.stangl@charite.de
Insights
Elevated homocysteine levels do not increase procedural risks for patients undergoing coronary angioplasty, stenting, or atherectomy. This study found no significant association between hyperhomocysteinemia and adverse outcomes after these cardiac interventions.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biochemistry
Background:
- Hyperhomocysteinemia is a known risk factor for atherosclerosis and thrombosis.
- The role of elevated homocysteine in procedural complications following coronary interventions was unclear.
Purpose of the Study:
- To investigate the association between elevated total plasma homocysteine (tHcy) levels and procedural excess risk in patients undergoing coronary interventions.
- To determine if hyperhomocysteinemia predicts adverse outcomes after percutaneous transluminal coronary angioplasty (PTCA), directional coronary atherectomy (DCA), or stenting.
Main Methods:
- A cohort of 648 consecutive coronary artery disease patients undergoing catheter interventions (PTCA, DCA, stenting) were analyzed.
- Fasting total plasma homocysteine levels were measured, with hyperhomocysteinemia defined as tHcy ≥15 micromol/l.
- A 30-day composite endpoint including target-vessel revascularization, myocardial infarction, and death was assessed.
Main Results:
- 12% of patients had elevated tHcy levels.
- No significant association was found between hyperhomocysteinemia and the 30-day composite endpoint in the overall intervention group (OR: 1.27, P=0.62).
- Hyperhomocysteinemia did not predict procedural complications in subgroups based on the intervention device used.
Conclusions:
- Hyperhomocysteinemia is not identified as a major risk factor for 30-day adverse events following PTCA, DCA, or stenting.
- These findings suggest that routine screening for homocysteine may not be necessary to assess procedural risk in these patients.
Background:
Since hyperhomocysteinaemia is an independent risk factor for development of atherosclerosis as well as for arterial and venous thrombosis we investigated whether elevated homocysteine levels are associated with procedural excess risk which complicates coronary interventions including coronary angioplasty (PTCA), stenting, or directional coronary atherectomy (DCA).
Design:
Consecutive cases receiving coronary catheter interventions.
Setting:
Tertiary referral centre in Germany.
Methods:
Fasting total plasma homocysteine levels (tHcy) were determined in 648 consecutive coronary artery disease patients who underwent catheter interventions (272 PTCA, 102 DCA, and 274 stenting). Hyperhomocysteinaemia was defined as tHcy >/=15 micromol/l. The patients were investigated for a 30-day composite endpoint, including need for target-vessel revascularization, myocardial infarction, and death.
Results:
Among the 648 patients, 78 (12%) demonstrated elevated tHcy levels. The composite endpoint occurred in 41 patients (6.3%). For the entire intervention group there was no evidence that hyperhomocysteinaemia was associated with excess procedural risk (odds ratio [OR]: 1.27; 95% confidence interval [CI]=0.52 to -3.13; P=0.62). In further analyses according to device, hyperhomocysteinaemia also failed to predict complications in the device related subgroups.
Conclusion:
The results indicate that hyperhomocysteinaemia is not a major risk factor for 30-day adverse events complicating PTCA, DCA, or stenting.