Copyright © 2002 by the European Society of Cardiology.
Association of plasma homocysteine with restenosis after percutaneous coronary angioplasty
Division of Cardiology, Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland
revised August 13, 2001; accepted August 15, 2001
Abstract
Aims Restenosis after percutaneous coronary angioplasty remains an important limitation of this procedure. This study evaluates whether elevated total plasma homocysteine levels contribute to the development of restenosis after coronary angioplasty.
Methods and Results Two hundred and five patients were recruited after successful angioplasty of at least one coronary stenosis (
50%). End-points were restenosis (50%) and a composite of major adverse cardiac events. Of the 205 patients, 183 (89·3%) underwent 6 months angiographic follow-up. Patients with restenosis had significantly higher homocysteine levels than those without (10·9± 3·9µmol.l–1 vs 9·3±3·8µmol.l–1, P<0·01). Homocysteine levels were significantly correlated to follow-up diameter stenosis (r=0·24, P=0·0001), especially in small vessels (<3mm) treated with balloon angioplasty only (r=0·40,P <0·0005). Late lumen loss at follow-up was significantly smaller with homocysteine levels below 9µmol.l–1 (0·62±0·82mm vs 0·90±0·77mm, P<0·01). Restenosis rate (25·3% vs 50·0%,P <0·001) and major adverse cardiac events (15·7% vs 28·4%,P <0·05) were also significantly lower in patients with homocysteine levels below 9µmol.l–1. Multivariate analysis did not weaken these findings.
Conclusion Total plasma homocysteine is a strong predictor of restenosis and major adverse cardiac events after coronary angioplasty. Thus, plasma homocysteine appears to be an important cardiovascular risk factor influencing outcome after successful coronary angioplasty.
Key Words: Angioplasty, death, homocysteine, myocardial infarction, restenosis
f1 Correspondence: Guido Schnyder, MD, UCSD Medical Center-MC 8784, Cardiology Division, 200 West Arbor Drive, San Diego, CA 92103, U.S.A.
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