Intermediate-Term Prognostic Value of Homocysteine in Acute Coronary Syndrome Complicated with or without Hypertension: A Multicenter Observational Cohort Study

Qiang Chen; Shiqiang Xiong; Xunshi Ding; Xiuqiong Yu; Caiyan Cui; Hong Su; Yu Long; Yan Luo; Zhen Zhang; Hanxiong Liu; Tao Xiang; Lin Cai

doi:10.31083/j.rcm2407210

Intermediate-Term Prognostic Value of Homocysteine in Acute Coronary Syndrome Complicated with or without Hypertension: A Multicenter Observational Cohort Study

Rev Cardiovasc Med. 2023 Jul 18;24(7):210. doi: 10.31083/j.rcm2407210. eCollection 2023 Jul.

Authors

Qiang Chen^{1

2}, Shiqiang Xiong¹, Xunshi Ding¹, Xiuqiong Yu¹, Caiyan Cui¹, Hong Su¹, Yu Long¹, Yan Luo¹, Zhen Zhang¹, Hanxiong Liu¹, Tao Xiang³, Lin Cai¹

Affiliations

¹ Department of Cardiology, the Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, 610014 Chengdu, Sichuan, China.
² Department of Cardiology, Sichuan Mianyang 404 Hospital, 621053 Mianyang, Sichuan, China.
³ Department of Emergency, the Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, 610014 Chengdu, Sichuan, China.

Abstract

Background: As a classical biomarker associated with hypertension, the prognostic value of homocysteine (Hcy) in the intermediate-term outcome of acute coronary syndrome (ACS) remains controversial. This study aimed to investigate the role of homocysteine in ACS patients with different blood pressure statuses.

Methods: A total of 1288 ACS patients from 11 general hospitals in Chengdu, China, from June 2015 to December 2019 were consecutively included in this observational study. The primary endpoint was defined as all-cause death. Secondary endpoints included cardiac death, nonfatal myocardial infarction (MI), unplanned revascularization and nonfatal stroke. The patients in the hypertension group (n = 788) were further stratified into hyperhomocysteinemia (H-Hcy, n = 245) and normal homocysteinaemia subgroups (N-Hcy, n = 543) around the cut-off value of 16.81 µmol/L. Similarly, the nonhypertensive patients were stratified into H-Hcy (n = 200) and N-Hcy subgroups (n = 300) around the optimal cut-off value of 14.00 µmol/L. The outcomes were compared between groups.

Results: The median follow-up duration was 18 months. During this period, 78 (6.05%) deaths were recorded. Kaplan‒Meier curves illustrated that H-Hcy had a lower survival probability than N-Hcy in both hypertension and nonhypertension groups (p $<$ 0.01). Multivariate Cox regression analysis revealed that H-Hcy was a predictor of intermediate-term mortality in ACS, regardless of blood pressure status.

Conclusions: Elevated Hcy levels predict intermediate-term all-cause mortality in ACS regardless of blood pressure status. This association could be conducive to risk stratification of ACS.

Clinical trial registration: The study was registered in the Chinese Clinical Trials Registry in China (ChiCTR1900025138).

Keywords: acute coronary syndrome; homocysteine; hypertension; prognosis.

Grants and funding

This research was supported by the Science and Technology Department of Sichuan, China (grant number 2021YJ0215), the National Natural Science Foundation of China (31600942), and Chengdu High-level Key Clinical Specialty Construction Project.