Plasma homocysteine levels and late outcome after coronary angioplasty

The aim of this study was to evaluate a possible relationship between homocysteine levels on admission and late outcome after successful percutaneous coronary intervention (PCI). Increasing evidence suggests that mild to moderate elevation of total plasma homocysteine is a graded and potentially modifiable risk factor for cardiovascular disease and death that appears to be largely independent of other traditional risk factors. A total of 549 patients were included after successful PCI of at least one coronary stenosis (≥50%). End points were cardiac death, nonfatal myocardial infarction (MI), target lesion revascularization (TLR), and a composite of major adverse cardiac events (MACE). The relationship between homocysteine levels and study endpoints was assessed. After a median (± SD) follow-up of 58 ± 20 weeks, 6 patients died of cardiac death, 14 were diagnosed with a new MI, and 71 underwent repeat TLR. A graded relationship between homocysteine levels (quartiles) and freedom from MACE was found (p = 0.01). Homocysteine levels (± SD) were associated with cardiac death (14.9 ± 1.7 μmol/l vs. 9.6 ± 4.3 μmol/l, p < 0.005), TLR (10.7 ± 4.4 μmol/l vs. 9.5 ± 4.3 μmol/l, p < 0.05), and overall MACE (11.0 ± 4.4 μmol/l vs. 9.4 ± 4.3 μmol/l, p < 0.005). These findings remained unchanged after adjustment for potential confounders. Plasma homocysteine is an independent predictor of mortality, nonfatal MI, TLR, and overall adverse late outcome after successful coronary angioplasty.