Kojoglanian Samuel A, Jorgensen Michael B, Wolde-Tsadik Girma, Burchette Raoul J, Aharonian Vicken J
Department of Internal Medicine, Section of Cardiology, and the Cardiac Catheterization aboratory, Kaiser Permanente Medical Center, Los Angeles, Calif, USA.
Am Heart J. 2003 Dec;146(6):1077-81. doi: 10.1016/S0002-8703(03)00518-0.
Controversy exists regarding the contribution made by elevated serum homocysteine evels in raising the risk of restenosis after percutaneous coronary interventions. The objective of this study was to determine whether elevated homocysteine evels increase the risk of restenosis.
Two hundred and two consecutive patients undergoing percutaneous coronary intervention with stents on previously nonintervened native coronary arteries were eligible for enrollment in the study. Before the percutaneous coronary intervention, a fasting serum homocysteine evel was drawn. Patients were followed-up by their primary cardiologists for recurrence of symptoms. Those patients who had a recurrence of anginal symptoms consistent with clinical restenosis were referred for a repeat angiogram. All other patients were followed-up medically. The homocysteine evels of the patients who had repeat angiography for recurrent symptoms were compared to those who were followed-up medically.
Age, stent ength, stent diameter, and homocysteine evels were all associated with an increased risk of restenosis in the univariate analysis. In the multiple ogistic regression model, the only variable that remained significant in relation to an increased risk of restenosis was homocysteine. There was a significant difference in the mean homocysteine evels between the restenosis group (13.7 micromol/L) and those without restenosis (9.6 micromol/L; P <.0001). A homocysteine evel > or =11.1 micromol/L was identified as the best threshold for an increased risk of restenosis with a sensitivity of 75.0% and specificity of 76.9% (OR 6.5, CI 2.3-18.6; P =.0004).
This study demonstrates that elevated homocysteine evels strongly correlate with an increased risk of restenosis.
关于血清同型半胱氨酸水平升高在经皮冠状动脉介入治疗后增加再狭窄风险方面所起的作用存在争议。本研究的目的是确定同型半胱氨酸水平升高是否会增加再狭窄风险。
连续202例在先前未干预的自身冠状动脉上接受支架置入的经皮冠状动脉介入治疗患者符合本研究入组条件。在经皮冠状动脉介入治疗前，采集空腹血清同型半胱氨酸水平。患者由其主治心脏病专家进行症状复发随访。那些出现与临床再狭窄一致的心绞痛症状复发的患者被转介进行重复血管造影。所有其他患者接受医学随访。将因复发症状进行重复血管造影的患者的同型半胱氨酸水平与接受医学随访的患者进行比较。
在单因素分析中，年龄、支架长度、支架直径和同型半胱氨酸水平均与再狭窄风险增加相关。在多因素逻辑回归模型中，与再狭窄风险增加相关的唯一显著变量是同型半胱氨酸。再狭窄组（13.7微摩尔/升）和无再狭窄组（9.6微摩尔/升；P<.0001）的平均同型半胱氨酸水平存在显著差异。同型半胱氨酸水平≥11.1微摩尔/升被确定为再狭窄风险增加的最佳阈值，敏感性为75.0%，特异性为76.9%（OR 6.5，CI 2.3 - 18.6；P =.0004）。
本研究表明，同型半胱氨酸水平升高与再狭窄风险增加密切相关。
