Korean Circ J.  2016 Mar;46(2):154-160. 10.4070/kcj.2016.46.2.154.

Prognostic Value of Elevated Homocysteine Levels in Korean Patients with Coronary Artery Disease: A Propensity Score Matched Analysis

• Kwon SW
• Kim JY
• Suh YJ
• Lee DH
• Yoon YW
• Lee BK
• Jung YH
• Choi EY
• Hong BK
• Rim SJ
• Kwon HM

• KMID: 2344466
• DOI: http://doi.org/10.4070/kcj.2016.46.2.154

Abstract

BACKGROUND AND OBJECTIVES
We sought to determine whether an elevated homocysteine (Hcy) level is associated with a worse prognosis in Korean patients with coronary artery disease (CAD).
SUBJECTS AND METHODS
A total of 5839 patients (60.4% male, mean age 61.3±11.2 years) with CAD were enrolled from 2000 to 2010 at Gangnam Severance Hospital. CAD was diagnosed by invasive coronary angiography. Laboratory values including Hcy level were obtained on the day of coronary angiography and analyses were performed shortly after sampling. Patients were divided into two groups according to their Hcy levels. Baseline risk factors, coronary angiographic findings, length of follow-up, and composite endpoints including cardiac death (CD) and non-fatal myocardial infarction (NFMI) were recorded. 1:1 propensity score matched analysis was also performed.
RESULTS
Over a mean follow-up period of 4.4±2.5 years, there were 132 composite endpoints (75 CD and 57 NFMI) with an event rate of 2.3%. Mean Hcy level was 9.9±4.3 µmol/L (normal Hcy 7.9±1.5 µmol/L and elevated Hcy 13.9±5.1 µmol/L). Kaplan-Meier survival analysis showed an association of elevated Hcy level with worse prognosis (p<0.0001). In addition, a multivariate Cox regression analysis showed an association of elevated Hcy level with worse prognosis for both the entire cohort (hazard ratio [HR] 2.077, 95% confidence interval [CI] 1.467-2.941, p<0.0001) and the propensity score matched cohort (HR 1.982, 95% CI 1.305-3.009, p=0.001).
CONCLUSION
Elevated Hcy level is associated with worse outcomes in Korean patients with CAD.

Keyword

Homocysteine; Coronary artery disease; Prognosis

MeSH Terms

Cohort Studies
Coronary Angiography
Coronary Artery Disease*
Coronary Vessels*
Death
Follow-Up Studies
Homocysteine*
Humans
Male
Myocardial Infarction
Prognosis
Propensity Score*
Risk Factors
Homocysteine

Figure

• 

  Fig. 1 Kaplan-Meier survival analysis according to Hcy levels. (A) Total cohort and (B) propensity score matched cohort. Hcy: homocysteine. CD: cardiac death, NFMI: non-fatal myocardial infarction.

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