Effect of hyperhomocysteine in patients after PCI for non-ST-segment elevation myocardial infarction, a retrospective study

Abstract

Background The prognostic value of homocysteine (HCY) in patients with coronary artery disease (CAD) remains controversial. The aim of this study was to investigate whether an elevated HCY level on admission can predict long-term outcomes in patients with Non-ST-Segment elevation myocardial infarction (NSTEMI) after percutaneous coronary intervention (PCI) with coronary artery stenting.Methods From Jinshan Hospital Affiliated to Fudan University from January 2018 to December 2021, 275 patients who were diagnosed with NSTEMI and successfully underwent emergency PCI were conducted. All these patients were divided into two groups according to fasting plasma HCY levels the day after the theterization: group Ⅰ (142 patients, <15 µmol/L) and group II (127 patients, ≥ 15 µmol/L).Primary and secondary outcome measures: The primary endpoint was the occurrence of major adverse cardiac events (MACE), including cardiac death, non-fatal myocardial infarction, stroke, and new lesion stenting.Results After a mean follow-up of 36 ± 14 months, patients in group II had a higher rate of MACE (33.9% vs. 17.6%, p = 0.002). The main difference between the two groups was cardiac death (8.7% vs. 2.1%, p = 0.016). The risk of long-term MACE remained significantly higher in patients with elevated HCY levels (≥ 15 µmol/L) with a hazard ratio of 1.29 (95% CI, 1.1-12.23, p = 0.034). Elevated HCY levels (≥ 15 µmol/L) were independently associated with an increased risk of long-term cardiovascular events in patients after PCI.Conclusion Thus, hyperhomocysteinemia may remain a useful prognostic marker for risk assessment in the clinical management of CAD patients.