Impact of elevated plasma total homocysteine concentration on coronary atherosclerosis in Chinese patients with acute myocardial infarction undergoing primary coronary intervention.

摘要

Elevated plasma total homocysteine (tHcy) has been considered to be a new risk factor for coronary atherosclerotic disease. However, the association has not been proven indisputably, and the strength of the relationship and the interaction of plasma tHcy with other conventional risk factors remain uncertain in the clinical setting of acute myocardial infarction (AMI). The aim of this study was to investigate whether an elevated plasma level of tHcy is an independent predictor of the late stage of coronary atherosclerotic lesions in Chinese patients with AMI, who are undergoing primary percutaneous coronary intervention (PCI). Plasma levels of tHcy were prospectively measured in 178 consecutive patients with ST-segment elevated AMI undergoing primary PCI. The plasma level of tHcy was also measured in 30 control subjects with normal coronary angiographic findings. The plasma level of tHcy was significantly higher in the patients with AMI than in control subjects (10.5 +/- 3.3 micromol/L versus 8.3 +/- 2.4 micromol/L, P = 0.0004). Multiple stepwise logistic regression analysis of the baseline characteristics demonstrated that smoking (P = 0.004) and creatinine level (P < 0.0001) were independent predictors of an elevated plasma level of tHcy. Moreover, an increased plasma level of tHcy (P = 0.003), female gender (P = 0.008), diabetes mellitus (P = 0.020), and the presence of previous myocardial infarction (P = 0.003) were independent predictors of the late stage of multivessel diffuse atherosclerosis (defined by > or = 2 epicardial vessels with moderate or severe diffuse atherosclerosis). In conclusion, this investigation supports the hypothesis that a raised homocysteine concentration is a strong risk factor for the late stage of diffuse coronary atherosclerosis in Chinese patients with AMI undergoing primary PCI. This result therefore raises the prospect of the need for major therapeutic research in Chinese patients.