Department of Cardiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China.
Department of Day Surgery Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
Cardiovasc Drugs Ther. 2019 Jun;33(3):353-361. doi: 10.1007/s10557-019-06866-0.
We conducted this systemic review and meta-analysis to investigate the association between elevated plasma homocysteine (Hcy) levels and recurrent restenosis and clinical outcomes after percutaneous coronary intervention (PCI).
PubMed, EMBASE, and Web of Science were systematically searched prior to May 2018. Studies evaluating the association between plasma Hcy levels and the occurrence of restenosis, major adverse cardiac events (MACE), all-cause mortality, cardiac death, non-fatal myocardial infarction (MI), and target lesion revascularization were identified.
A total of 19 articles with 4340 participants were identified. Higher Hcy levels were not associated with an increased risk of restenosis (relative risk (RR) = 1.10, 95% CI 0.90-1.33). Hcy levels in the restenosis group were not significantly higher than in the non-restenosis group (weighted mean difference = 0.70, 95% CI - 0.23-1.63). Subgroup analysis revealed that higher Hcy levels were not associated with restenosis after stenting but appeared to increase the risk of restenosis after angioplasty. Elevated Hcy levels increased the risk of all-cause mortality by an average of 3.19-fold (RR = 3.19, 95% CI 1.90-5.34, P = 0.000), the risk of MACE by 1.51-fold (RR = 1.51, 95% CI 1.23-1.85, P = 0.000), and the risk of cardiac death by 2.76-fold (RR = 2.76, 95% CI 1.44-5.32, P = 0.000) but appeared not to increase the risk of non-fatal MI (RR = 1.36, 95% CI 0.89-2.09).
Our meta-analysis suggests that although there is no clear association between higher Hcy levels and restenosis following stent implantation, higher Hcy levels appeared to increase the risk of restenosis after coronary angioplasty and also increased the risk of all-cause mortality, MACE, and cardiac death after PCI.
The protocol of this meta-analysis was registered on PROSPERO (CRD42018096466). ( http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018096466 ).
本系统评价和荟萃分析旨在研究血浆同型半胱氨酸（Hcy）水平升高与经皮冠状动脉介入治疗（PCI）后再狭窄和临床结局之间的关系。
在 2018 年 5 月之前，系统地检索了 PubMed、EMBASE 和 Web of Science 以查找评估血浆 Hcy 水平与再狭窄、主要不良心脏事件（MACE）、全因死亡率、心脏性死亡、非致死性心肌梗死（MI）和靶病变血运重建发生之间关系的研究。
共纳入了 19 项包含 4340 名参与者的研究。较高的 Hcy 水平与再狭窄风险增加无关（相对风险（RR）=1.10，95%CI 0.90-1.33）。再狭窄组的 Hcy 水平并不显著高于非再狭窄组（加权均数差=0.70，95%CI -0.23-1.63）。亚组分析显示，支架置入后较高的 Hcy 水平与再狭窄无关，但似乎增加了经皮冠状动脉成形术后再狭窄的风险。Hcy 水平升高使全因死亡率平均增加 3.19 倍（RR=3.19，95%CI 1.90-5.34，P=0.000），MACE 风险增加 1.51 倍（RR=1.51，95%CI 1.23-1.85，P=0.000），心脏性死亡风险增加 2.76 倍（RR=2.76，95%CI 1.44-5.32，P=0.000），但似乎不增加非致死性 MI 风险（RR=1.36，95%CI 0.89-2.09）。
本荟萃分析表明，尽管支架植入术后较高的 Hcy 水平与再狭窄之间无明确关联，但 Hcy 水平升高似乎增加了经皮冠状动脉成形术后再狭窄的风险，并且增加了 PCI 后的全因死亡率、MACE 和心脏性死亡的风险。
本荟萃分析的方案已在 PROSPERO（CRD42018096466）上注册。（http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018096466）。
