Martín-Herrero Francisco, Martín-Moreiras Javier, Pabón Pedro, Sánchez Pedro L, Moríñigo-Muñoz José Luis, Jimenez-Candil Javier, Cruz-González Ignacio, Alberca Ignacio, González-Porras José Ramón, Martín-Luengo Cándido
Cardiology Department, University Hospital, Salamanca, Spain.
Int J Cardiol. 2007 May 31;118(2):183-8. doi: 10.1016/j.ijcard.2006.06.046. Epub 2006 Oct 3.
Despite the well-known pro-thrombotic and pro-inflammatory plasma homocysteine effects, it remains uncertain whether these effects can be associated with an adverse cardiac outcome in young patients admitted with acute coronary syndromes.
Homocysteine levels were determined within 24 h after admission in 244 consecutive patients aged less than 56 years who presented with an acute coronary syndrome. We evaluated the relationship between homocysteine and both short-term (death, myocardial [re]infarction), and long-term prognosis (death, recurrent acute coronary syndrome and/or ischemic stroke), after 3.4+/-1.7 years of follow-up.
Homocysteine levels were similar in patients both with and without in-hospital event: 8.65 (5.36-10.48) vs. 8.98 (7.38-11.13) micromol/l, p=NS. However, patients who presented with the combined event during follow-up had higher homocysteine levels than those free of the event: 10.54 (7.90-11.76) micromol/l vs. 8.52 (7.11-10.23) micromol/l, p=0.001. Patients who either died (13.78 vs. 8.87 micromol/l, p=0.012) or had a myocardial infarction (10.75 vs. 8.76 micromol/l, p=0.006) or unstable angina (10.46 vs. 8.76, p=0.006) during follow-up had higher homocysteine levels. According to the Cox regression analysis: age [hazard ratio 1.05, CI 95%, 0.99-1.10], left ventricular ejection fraction < or =40% [hazard ratio 1.93, CI 95%, 0.98-3.79], and homocysteine tertile 3 [hazard ratio 2.05, CI 95%, 1.13-3.71] were the significant determinants of the combined adverse event during follow-up. Although 41 (18%) of patients presented the TT genotype of the methylen-tetrahydrofolate-reductase thermolabile variant mutation, its occurrence had a neutral effect on morbid-mortality.
High homocysteine levels at admission strongly predict late cardiac events in young patients with acute coronary syndromes.
尽管血浆同型半胱氨酸具有众所周知的促血栓形成和促炎作用，但这些作用是否与急性冠状动脉综合征年轻患者的不良心脏结局相关仍不确定。
对244例年龄小于56岁的急性冠状动脉综合征连续患者在入院后24小时内测定同型半胱氨酸水平。在3.4±1.7年的随访后，我们评估了同型半胱氨酸与短期（死亡、心肌[再]梗死）和长期预后（死亡、复发性急性冠状动脉综合征和/或缺血性中风）之间的关系。
有和没有院内事件的患者同型半胱氨酸水平相似：8.65（5.36 - 10.48）与8.98（7.38 - 11.13）微摩尔/升，p =无显著性差异。然而，随访期间出现联合事件患者的同型半胱氨酸水平高于无此事件患者：10.54（7.90 - 11.76）微摩尔/升对8.52（7.11 - 10.23）微摩尔/升，p = 0.001。随访期间死亡（13.78对8.87微摩尔/升，p = 0.012）、发生心肌梗死（10.75对8.76微摩尔/升，p = 0.006）或不稳定型心绞痛（10.46对8.76，p = 0.006）的患者同型半胱氨酸水平更高。根据Cox回归分析：年龄[风险比1.05，95%可信区间，0.99 - 1.10]、左心室射血分数≤40%[风险比1.93，95%可信区间，0.98 - 3.79]和同型半胱氨酸三分位数3[风险比2.05，95%可信区间，1.13 - 3.71]是随访期间联合不良事件的显著决定因素。尽管4l（18%）例患者存在亚甲基四氢叶酸还原酶不耐热变异突变的TT基因型，但其出现对病死情况具有中性影响。
入院时高同型半胱氨酸水平强烈预示急性冠状动脉综合征年轻患者的晚期心脏事件。
