Foussas Stefanos G, Zairis Michael N, Makrygiannis Stamatis S, Manousakis Stavros J, Patsourakos Nikolaos G, Adamopoulou Evdokia N, Beldekos Demetrios J, Melidonis Andreas I, Handanis Stylianos M, Manolis Athanasios J, Hatzisavvas John J, Argyrakis Spyros K
Department of Cardiology, Tzanio Hospital, Piraeus, Greece.
Int J Cardiol. 2008 Mar 14;124(3):312-8. doi: 10.1016/j.ijcard.2007.02.011. Epub 2007 Apr 12.
To evaluate the possible independent impact of circulating total homocysteine (tHcy) levels on long-term cardiovascular mortality, in patients with either ST-segment elevation myocardial infarction (STEMI), or non-ST-segment elevation acute coronary syndromes (NSTE-ACS).
A total of 458 STEMI and 476 NSTE-ACS patients who presented consecutively, within the first 12 and 24 h of index pain respectively were studied. Each cohort was divided according to tertiles of circulating tHcy levels upon presentation. Early (30 days) and late (31 days through 5 years) cardiovascular mortality was the predefined study endpoint.
There was no difference in the risk of 30-day cardiovascular death among the tertiles of tHcy in patients with STEMI (7.2%, 8.5% and 12.4% for the first, second and third tertiles respectively; p(trend)=0.3) or NSTE-ACS (3.1%, 3.8% and 5.7% for the first, second and third tertiles respectively; p(trend)=0.5). Patients in the upper tHcy tertile were at significantly higher unadjusted risk of late (from 31 days trough 5 years) cardiovascular death than those in the other two tertiles in STEMI (23.4%, 27.9% and 41.8% for the first, second and third tertiles respectively; p(trend) <0.001), and NSTE-ACS (24.7%, 28.1% and 45.6% for the first, second and third tertiles respectively; p(trend) <0.001) cohorts. However, after adjustment for baseline differences, there was no significant difference in the risk of late cardiovascular death among tHcy tertiles in either cohort. When circulating tHcy levels were treated as a continuous variable, they were significantly associated with late cardiovascular death (p<0.001 for both cohorts) by univariate Cox regression analysis, but not by multivariate Cox regression analysis (p=0.8, and p=1 for STEMI and NSTE-ACS cohorts, respectively).
Based on the present data circulating tHcy levels determined upon admission do not serve as an independent predictor of long-term cardiovascular mortality in patients with either STEMI or NSTE-ACS.
评估循环总同型半胱氨酸（tHcy）水平对ST段抬高型心肌梗死（STEMI）或非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者长期心血管死亡率可能产生的独立影响。
分别对在首次胸痛发作后的前12小时和24小时内连续就诊的458例STEMI患者和476例NSTE-ACS患者进行研究。每个队列根据就诊时循环tHcy水平的三分位数进行划分。早期（30天）和晚期（31天至5年）心血管死亡率是预先定义的研究终点。
STEMI患者中，tHcy三分位数之间30天心血管死亡风险无差异（第一、第二和第三三分位数分别为7.2%、8.5%和12.4%；p趋势=0.3），NSTE-ACS患者中也无差异（第一、第二和第三三分位数分别为3.1%、3.8%和5.7%；p趋势=0.5）。在STEMI队列中，tHcy最高三分位数的患者晚期（从31天到5年）心血管死亡的未调整风险显著高于其他两个三分位数的患者（第一、第二和第三三分位数分别为23.4%、27.9%和41.8%；p趋势<0.001），NSTE-ACS队列中也是如此（第一、第二和第三三分位数分别为24.7%、28.1%和45.6%；p趋势<0.001）。然而，在对基线差异进行调整后，两个队列中tHcy三分位数之间晚期心血管死亡风险均无显著差异。当将循环tHcy水平视为连续变量时，单因素Cox回归分析显示其与晚期心血管死亡显著相关（两个队列p均<0.001），但多因素Cox回归分析未显示相关性（STEMI和NSTE-ACS队列分别为p=0.8和p=1）。
根据目前的数据，入院时测定的循环tHcy水平不能作为STEMI或NSTE-ACS患者长期心血管死亡率的独立预测指标。
