Cardiology Department, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Valencia, Spain.
Centro de Investigación Biomédica en Red (CIBER-Cardiovascular), Calle de Melchor Fernández Almagro, Madrid, Spain.
Cardiol J. 2021;28(4):598-606. doi: 10.5603/CJ.a2020.0170. Epub 2020 Dec 21.
There are no well-established predictors of recurrent ischemic coronary events after an acute coronary syndrome (ACS). Higher levels of homocysteine have been reported to be associated with an increased atherosclerotic burden. The primary endpoint was to assess the relationship between homocysteine at discharge and very long-term recurrent myocardial infarction (MI).
1306 consecutive patients with ACS were evaluated (862 with non-ST-segment elevation ACS [NSTEACS] and 444 with ST-segment elevation myocardial infarction [STEMI]) discharged from October 2000 to June 2003 in a single teaching-center. The relationship between homocysteine at discharge and recurrent MI was evaluated through bivariate negative binomial regression accounting for mortality as a competitive event.
The mean age was 66.8 ± 12.4 years, 69.1% were men, and 32.2% showed prior diabetes mellitus. Most of the patients were admitted for an NSTEACS (66.0%). The median (interquartile range) GRACE risk score, Charlson comorbidity index, and homocysteine were 144 (122-175) points, 1 (1-2) points, and 11.9 (9.3-15.6) μmol/L, respectively. In-hospital revascularization was performed in 26.3% of patients. At a median follow-up of 9.7 (4.5-15.1) years, 709 (54.3%) deaths were registered and 779 recurrent MI in 478 (36.6%) patients. The rates of recurrent MI were higher in patients in the upper homocysteine quartiles (p < 0.001). After a multivariate adjustment, homocysteine along its continuum remained almost linearly associated with a higher risk of recurrent MI (p = 0.001) and all-cause mortality (p < 0.001).
In patients with ACS, higher homocysteine levels identified those at a higher risk of recurrent MI at very long-term follow-up.
急性冠状动脉综合征（ACS）后复发性缺血性冠状动脉事件尚无明确的预测指标。已有研究报告称，同型半胱氨酸水平升高与动脉粥样硬化负担增加有关。主要终点是评估出院时同型半胱氨酸与极长程复发性心肌梗死（MI）之间的关系。
评估了 2000 年 10 月至 2003 年 6 月期间在单教学中心出院的 1306 例连续 ACS 患者（862 例非 ST 段抬高型 ACS [NSTEACS]和 444 例 ST 段抬高型心肌梗死 [STEMI]）。通过双变量负二项式回归评估出院时同型半胱氨酸与复发性 MI 之间的关系，同时考虑死亡率作为竞争事件。
患者的平均年龄为 66.8 ± 12.4 岁，69.1%为男性，32.2%有既往糖尿病。大多数患者因 NSTEACS 入院（66.0%）。中位数（四分位距）GRACE 风险评分、Charlson 合并症指数和同型半胱氨酸分别为 144（122-175）分、1（1-2）分和 11.9（9.3-15.6）μmol/L。26.3%的患者接受了院内血运重建。中位随访 9.7（4.5-15.1）年后，登记了 709 例（54.3%）死亡，478 例（36.6%）患者发生了 779 例复发性 MI。同型半胱氨酸四分位较高的患者复发性 MI 发生率更高（p < 0.001）。在多变量调整后，同型半胱氨酸及其连续变量仍与复发性 MI（p = 0.001）和全因死亡率（p < 0.001）的风险升高呈几乎线性相关。
在 ACS 患者中，较高的同型半胱氨酸水平可确定在极长程随访中复发性 MI 风险较高的患者。
