Relationship between serum homocysteine levels and long-term outcomes in patients with ST-segment elevation myocardial infarction

Background:The mortality of cardiovascular disease is constantly rising,and novel biomarkers help us predict residual risk.This study aimed to evaluate the predictive value of serum homocysteine (HCY) levels on prognosis in patients with ST-segment elevation myocardial infarction (STEMI).Methods:The 419 consecutive patients with STEMI,treated at one medical center,from March 2010 to December 2015 were retrospectively investigated.Peripheral blood samples were obtained within 24 h of admission and HCY concentrations were measured using an enzymatic cycling assay.The patients were divided into high HCY level (H-HCY) and low HCY level (L-HCY) groups.Short- and long-term outcomes were compared,as were age-based subgroups (patients aged 60 years and younger vs.those older than 60 years).Statistical analyses were mainly conducted by Student t-test,Chi-squared test,logistic regression,and Cox proportional-hazards regression.Results:The H-HCY group had more males (84.6% vs.75.4%,P=0.018),and a lower prevalence of diabetes (20.2% vs.35.5%,P<0.001),compared with the L-HCY group.During hospitalization,there were seven mortalities in the L-HCY group and 10 in the H-HCY group (3.3% vs.4.8%,P= 0.440).During the median follow-up period of 35.8 (26.9–46.1) months,33 (16.2%) patients in the L-HCY group and 48 (24.2%) in the H-HCY group experienced major adverse cardiovascular and cerebrovascular events (MACCE)(P=0.120).History of hypertension (hazard ratio [HR]:1.881,95% confidence interval [CI]:1.178–3.005,P=0.008) and higher Killip class (HR:1.923,95% CI:1.419–2.607,P<0.001),but not HCY levels (HR:1.007,95% CI:0.987–1.027,P=0.507),were significantly associated with long-term outcomes.However,the subgroup analysis indicated that in older patients,HCY levels were significantly associated with long-term outcomes (HR:1.036,95% CI:1.011–1.062,P=0.005).Conclusion:Serum HCY levels did not independently predict in-hospital or long-term outcomes in patients with STEMI;however,among elderly patients with STEMI,this study revealed a risk profile for late outcomes that incorporated HCY level.

Prognostic significance of the hemoglobin A1c level in non-diabetic patients undergoing percutaneous coronary intervention: a meta-analysis

Background:The predictive value of hemoglobin A1c(HbA1c)levels in non-diabetic patients with myocardial infarction undergoing percutaneous coronary intervention(PCI)is still controversial.This study aimed to evaluate whether HbA1c levels were independently associated with adverse clinical outcomes in non-diabetic patients with coronary artery disease(CAD)who had undergone PCI by performing a meta-analysis of cohort studies.Methods:This meta-analysis included non-diabetic patients with CAD who had undergone PCI.A systematic search for publications listed in the PubMed,Embase,and Cochrane Library databases from commencement to December 2018 was conducted.Studies evaluating the adverse clinical outcomes according to abnormal HbA1c levels in non-diabetic patients diagnosed with CAD who had undergone PCI were eligible.The primary outcomes were long-term all-cause deaths and long-term major adverse cardiac events,and the secondary outcome was short-term all-cause deaths.The meta-analysis was conducted with RevMan 5.3 and Stata software 14.0.Odds ratios(ORs)were pooled using a random or fixed-effects model,depending on the heterogeneity of the included studies.Sub-group analysis or sensitivity analysis was conducted to explore potential sources of heterogeneity,when necessary.Results:Six prospective cohort studies involving 10,721 patients met the inclusion criteria.From the pooled analysis,abnormal HbA1c levels were associated with increased risk for long-term all-cause death(OR 1.39,95%confidence interval[CI]1.16-1.68,P=0.001,I2=45%).Sub-group analysis suggested that abnormal HbA1c levels between 6.0%and 6.5%predicted higher long-term major adverse cardiac event(including all-cause deaths,non-fatal myocardial infarction,target lesion revascularization,target vessel revascularization,recurrent acute myocardial infarction,heart failure requiring hospitalization,and stent thrombosis)risk(OR 2.05,95%CI 1.46-2.87,P<0.001,I2=0).Contrarily,elevated HbA1c levels were not associated with increased risk of short-term all-cause death(OR 1.16,95%CI 0.88-1.54,P=0.300,I2=0).Conclusions:An abnormal HbA1c level is an independent risk factor for long-term adverse clinical events in non-diabetic patients with CAD after PCI.Strict control of HbA1c levels may improve patient survival.Further studies in different countries and prospective cohort studies with a large sample size are required to verify the association.