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Intermediate-Term Prognostic Value of Homocysteine in Acute Coronary Syndrome Complicated with or without
Qiang Chen1,2, Shiqiang Xiong1, Xunshi Ding1
1Department of Cardiology, the Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, 610014 Chengdu, Sichuan, China.
Insights
Elevated homocysteine (Hcy) levels predict intermediate-term mortality in acute coronary syndrome (ACS) patients, irrespective of their blood pressure status. This finding aids in the risk stratification of ACS patients.
Area of Science:
- Cardiology
- Clinical Biochemistry
- Public Health
Background:
- Homocysteine (Hcy) is a classical biomarker associated with hypertension.
- The prognostic value of Hcy in acute coronary syndrome (ACS) intermediate-term outcomes is debated.
- This study investigates Hcy's role in ACS patients across different blood pressure statuses.
Purpose of the Study:
- To determine the prognostic value of homocysteine (Hcy) in intermediate-term outcomes for acute coronary syndrome (ACS) patients.
- To assess whether elevated Hcy levels impact mortality differently based on hypertension status.
- To evaluate Hcy as a potential biomarker for risk stratification in ACS.
Main Methods:
- An observational study included 1288 ACS patients from June 2015 to December 2019.
- Patients were stratified by blood pressure (hypertension vs. nonhypertension) and Hcy levels (hyperhomocysteinemia vs. normal).
- Primary endpoint was all-cause death; secondary endpoints included cardiac death, MI, revascularization, and stroke, analyzed using Kaplan-Meier and Cox regression.
Main Results:
- A median follow-up of 18 months revealed 78 (6.05%) deaths.
- Hyperhomocysteinemia (H-Hcy) was associated with lower survival probability compared to normal Hcy (N-Hcy) in both hypertensive and nonhypertensive groups (p < 0.01).
- Multivariate Cox regression confirmed H-Hcy as an independent predictor of intermediate-term mortality in ACS, regardless of blood pressure.
Conclusions:
- Elevated Hcy levels are a significant predictor of intermediate-term all-cause mortality in ACS patients.
- This association holds true irrespective of the patient's blood pressure status (hypertension or normotension).
- Measuring Hcy levels can contribute to improved risk stratification strategies for ACS patients.
Background:
As a classical biomarker associated with hypertension, the prognostic value of homocysteine (Hcy) in the intermediate-term outcome of acute coronary syndrome (ACS) remains controversial. This study aimed to investigate the role of homocysteine in ACS patients with different blood pressure statuses.
Methods:
A total of 1288 ACS patients from 11 general hospitals in Chengdu, China, from June 2015 to December 2019 were consecutively included in this observational study. The primary endpoint was defined as all-cause death. Secondary endpoints included cardiac death, nonfatal myocardial infarction (MI), unplanned revascularization and nonfatal stroke. The patients in the hypertension group (n = 788) were further stratified into hyperhomocysteinemia (H-Hcy, n = 245) and normal homocysteinaemia subgroups (N-Hcy, n = 543) around the cut-off value of 16.81 µmol/L. Similarly, the nonhypertensive patients were stratified into H-Hcy (n = 200) and N-Hcy subgroups (n = 300) around the optimal cut-off value of 14.00 µmol/L. The outcomes were compared between groups.
Results:
The median follow-up duration was 18 months. During this period, 78 (6.05%) deaths were recorded. Kaplan‒Meier curves illustrated that H-Hcy had a lower survival probability than N-Hcy in both hypertension and nonhypertension groups (p 0.01). Multivariate Cox regression analysis revealed that H-Hcy was a predictor of intermediate-term mortality in ACS, regardless of blood pressure status.
Conclusions:
Elevated Hcy levels predict intermediate-term all-cause mortality in ACS regardless of blood pressure status. This association could be conducive to risk stratification of ACS.
Clinical Trial Registration:
The study was registered in the Chinese Clinical Trials Registry in China (ChiCTR1900025138).
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