1. Homocysteine and long-term recurrent infarction following an acute coronary syndrome
- Author
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Eduardo Núñez, Anna Mollar, Teresa García-Ballester, Gema Miñana, Jorge Martí-Cervera, Juan Sanchis, Ernesto Valero, Carolina Gil-Cayuela, Vicent Bodí, Julio Núñez, Lorenzo Fácila, Francisco J. Chorro, Begoña Zorio, Maria Marco, and Producción Científica UCH 2021
- Subjects
Male ,medicine.medical_specialty ,Acute coronary syndrome ,Homocysteine ,medicine.medical_treatment ,Coronary heart disease - Risk factors ,Infarto de miocardio - Factores de riesgo ,Enfermedad coronaria - Factores de riesgo ,Infarction ,Clinical Cardiology ,Revascularization ,Coronary artery disease ,chemistry.chemical_compound ,Interquartile range ,Risk Factors ,Internal medicine ,Myocardial infarction - Risk factors ,medicine ,Humans ,Myocardial infarction ,Acute Coronary Syndrome ,Aged ,acute coronary syndrome, coronary artery disease, homocysteine, recurrent myocardial infarction, risk factors ,Cardiovascular system - Diseases - Risk factors ,Framingham Risk Score ,business.industry ,Enfermedades cardiovasculares - Factores de riesgo ,General Medicine ,medicine.disease ,Hospitalization ,chemistry ,Cardiology ,ST Elevation Myocardial Infarction ,Cardiology and Cardiovascular Medicine ,business - Abstract
En Cardiology Journal. Gdańsk (Polonia) : Via Medica. Vol. 28, n. 4 (01 jul. 2021), pp. 598-606. ISSN 1897-5593. e-ISSN 1898-018X. Este artículo se encuentra disponible en la siguiente URL: https://journals.viamedica.pl/cardiology_journal/article/view/CJ.a2020.0170/52602 En este artículo de investigación también participan: Maria Marco, Teresa García-Ballester, Begoña Zorio, Eduardo Núñez, Francisco J. Chorro, Juan Sanchis y Julio Núñez. Background: There are no well-established predictors of recurrent ischemic coronary events after an acute coronary syndrome (ACS). Higher levels of homocysteine have been reported to be associated with an increased atherosclerotic burden. The primary endpoint was to assess the relationship between homocysteine at discharge and very long-term recurrent myocardial infarction (MI). Methods: 1306 consecutive patients with ACS were evaluated (862 with non-ST-segment elevation ACS [NSTEACS] and 444 with ST-segment elevation myocardial infarction [STEMI]) discharged from October 2000 to June 2003 in a single teaching-center. The relationship between homocysteine at discharge and recurrent MI was evaluated through bivariate negative binomial regression accounting for mortality as a competitive event. Results: The mean age was 66.8 ± 12.4 years, 69.1% were men, and 32.2% showed prior diabetes mellitus. Most of the patients were admitted for an NSTEACS (66.0%). The median (interquartile range) GRACE risk score, Charlson comorbidity index, and homocysteine were 144 (122–175) points, 1 (1–2) points, and 11.9 (9.3–15.6) μmol/L, respectively. In-hospital revascularization was performed in 26.3% of patients. At a median follow-up of 9.7 (4.5–15.1) years, 709 (54.3%) deaths were registered and 779 recurrent MI in 478 (36.6%) patients. The rates of recurrent MI were higher in patients in the upper homocysteine quartiles (p < 0.001). After a multivariate adjustment, homocysteine along its continuum remained almost linearly associated with a higher risk of recurrent MI (p = 0.001) and all-cause mortality (p < 0.001). Conclusions: In patients with ACS, higher homocysteine levels identified those at a higher risk of recurrent MI at very long-term follow-up.
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- 2020