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Published on: May 28, 2019
Relationship between serum homocysteine levels and long-term outcomes in patients with ST-segment elevation
Jin Si1, Xue-Wen Li2,3, Yang Wang4
1Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
Insights
Serum homocysteine (HCY) levels did not predict outcomes in ST-segment elevation myocardial infarction (STEMI) patients overall. However, elevated HCY levels were associated with poorer long-term prognosis in elderly STEMI patients.
Area of Science:
- Cardiology
- Biomarkers
- Clinical Research
Background:
- Cardiovascular disease mortality is rising globally.
- Novel biomarkers are crucial for predicting residual risk.
- Evaluating serum homocysteine (HCY) in ST-segment elevation myocardial infarction (STEMI) prognosis is important.
Purpose of the Study:
- To assess the predictive value of serum homocysteine (HCY) levels on prognosis in STEMI patients.
- To investigate the association between HCY levels and short- and long-term outcomes.
- To explore HCY's predictive role in different age subgroups.
Main Methods:
- Retrospective analysis of 419 STEMI patients.
- Measurement of serum HCY concentrations within 24 hours of admission.
- Comparison of outcomes between high-HCY and low-HCY groups, including age-based subgroups.
Main Results:
- No significant association between HCY levels and in-hospital mortality or overall long-term major adverse cardiovascular and cerebrovascular events (MACCE).
- Hypertension history and higher Killip class were significant predictors of long-term outcomes.
- Subgroup analysis revealed HCY levels significantly predicted long-term outcomes in elderly STEMI patients (age > 60).
Conclusions:
- Serum HCY levels are not an independent predictor of outcomes in the general STEMI population.
- HCY levels may serve as a valuable prognostic marker for long-term outcomes specifically in elderly STEMI patients.
- Incorporating HCY levels into risk assessment may refine prognosis prediction in older STEMI individuals.
Background:
The mortality of cardiovascular disease is constantly rising, and novel biomarkers help us predict residual risk. This study aimed to evaluate the predictive value of serum homocysteine (HCY) levels on prognosis in patients with ST-segment elevation myocardial infarction (STEMI).
Methods:
The 419 consecutive patients with STEMI, treated at one medical center, from March 2010 to December 2015 were retrospectively investigated. Peripheral blood samples were obtained within 24 h of admission and HCY concentrations were measured using an enzymatic cycling assay. The patients were divided into high HCY level (H-HCY) and low HCY level (L-HCY) groups. Short- and long-term outcomes were compared, as were age-based subgroups (patients aged 60 years and younger vs. those older than 60 years). Statistical analyses were mainly conducted by Student t-test, Chi-squared test, logistic regression, and Cox proportional-hazards regression.
Results:
The H-HCY group had more males (84.6% vs. 75.4%, P = 0.018), and a lower prevalence of diabetes (20.2% vs. 35.5%, P < 0.001), compared with the L-HCY group. During hospitalization, there were seven mortalities in the L-HCY group and 10 in the H-HCY group (3.3% vs. 4.8%, P = 0.440). During the median follow-up period of 35.8 (26.9-46.1) months, 33 (16.2%) patients in the L-HCY group and 48 (24.2%) in the H-HCY group experienced major adverse cardiovascular and cerebrovascular events (MACCE) (P = 0.120). History of hypertension (hazard ratio [HR]: 1.881, 95% confidence interval [CI]: 1.178-3.005, P = 0.008) and higher Killip class (HR: 1.923, 95% CI: 1.419-2.607, P < 0.001), but not HCY levels (HR: 1.007, 95% CI: 0.987-1.027, P = 0.507), were significantly associated with long-term outcomes. However, the subgroup analysis indicated that in older patients, HCY levels were significantly associated with long-term outcomes (HR: 1.036, 95% CI: 1.011-1.062, P = 0.005).
Conclusion:
Serum HCY levels did not independently predict in-hospital or long-term outcomes in patients with STEMI; however, among elderly patients with STEMI, this study revealed a risk profile for late outcomes that incorporated HCY level.
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