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Homocysteine and long-term recurrent infarction following an acute coronary syndrome
Gema Miñana1,2, Carolina Gil-Cayuela2,3, Lorenzo Fácila4
1Cardiology Department, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Valencia, Spain.
Insights
Higher homocysteine levels after acute coronary syndrome (ACS) predict long-term risk of recurrent myocardial infarction (MI). This finding helps identify high-risk patients for targeted interventions to prevent future cardiac events.
Area of Science:
- Cardiology
- Biochemistry
- Public Health
Background:
- Predicting recurrent ischemic coronary events after acute coronary syndrome (ACS) remains challenging.
- Elevated homocysteine levels are linked to increased atherosclerotic burden.
Purpose of the Study:
- To assess the relationship between homocysteine levels at discharge and very long-term recurrent myocardial infarction (MI) in ACS patients.
Main Methods:
- 1306 ACS patients (NSTEACS and STEMI) were evaluated.
- Bivariate negative binomial regression was used to analyze the association between discharge homocysteine and recurrent MI, accounting for mortality.
Main Results:
- Higher homocysteine quartiles were associated with increased rates of recurrent MI (p < 0.001).
- Multivariate analysis confirmed a linear association between homocysteine and higher risk of recurrent MI (p = 0.001) and all-cause mortality (p < 0.001).
Conclusions:
- Elevated homocysteine levels at discharge are a significant predictor of recurrent MI in ACS patients.
- Homocysteine serves as a valuable biomarker for identifying individuals at higher risk for adverse cardiovascular outcomes long-term.
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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