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Hyperhomocysteinemia is an independent predictor of long-term clinical outcomes in Chinese octogenarians with acute coronary syndrome

Authors Fu Z, Qian G, Xue H, Guo J, Chen L, Yang X, Shen M, Dong W, Chen Y

Received 2 July 2015

Accepted for publication 17 August 2015

Published 15 September 2015 Volume 2015:10 Pages 1467—1474

DOI https://doi.org/10.2147/CIA.S91652

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Carl Fortin

Peer reviewer comments 3

Editor who approved publication: Professor Zhi-Ying Wu

Zhenhong Fu,1,* Geng Qian,1,* Hao Xue,1,* Jun Guo,1 Lian Chen,1 Xia Yang,1 Mingzhi Shen,2 Wei Dong,1 Yundai Chen1

1Department of Cardiology, Chinese People’s Liberation Army General Hospital, Beijing, People’s Republic of China; 2Department of Cardiology, Hainai Branch of Chinese People’s Liberation Army General Hospital, Sanya, Hainan, People’s Republic of China

*These authors contributed equally to this work

Objective: To evaluate the prognostic value of homocysteine (Hcy) in Chinese acute coronary syndrome (ACS) octogenarians.
Methods: The study cohort comprised 660 consecutive ACS octogenarians who underwent coronary angiography. We classified the patients into three groups according to Hcy tertiles. Kaplan–Meier method was performed for survival and major adverse cardiac events (MACE) rates. Multivariate Cox regression was performed to identify mortality predictors. Receiver operating characteristic curve analysis was performed to predict the cutoff value of Hcy for all-cause mortality.
Results: The follow-up period was 28 (inter-quartile range: 16–38) months. Diastolic blood pressure, ratios of male, renal failure and old myocardial infarction in high plasma level Hcy (H-Hcy) group were higher than those in low (L-Hcy) and middle (M-Hcy) plasma level of Hcy groups (P<0.05). The Hcy level was positively correlated with uric acid level (r=0.211, P=0.001) and Cystatin C (Cys C) level (r=0.212, P=0.001) and negatively correlated with estimated glomerular filtration rate (r=−0.148, P=0.018). For the long-term outcomes, the cumulative survival rate of H-Hcy group was significantly lower than that of L-Hcy and M-Hcy groups (P=0.006). All-cause mortality and MACE of H-Hcy group were higher than those of L-Hcy and M-Hcy group (P=0.0001, P=0.0008). Hcy is an independent predictor for long-term all-cause mortality (odds ratio =2.26, 95% CI=1.23–4.16, P=0.023) and MACE (odds ratio =1.91, 95% CI=1.03–3.51, P=0.039). Receiver operating characteristic curve analysis indicated the predictive cutoff value of Hcy for all-cause mortality was 17.67 µmol/L (0.667, 0.681).
Conclusion: In ACS octogenarians, hyperhomocysteinemia is an important predictor for long-term all-cause mortality and MACE.

Keywords: acute coronary syndrome, octogenarian, homocysteine, clinical risk factors, outcomes

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