Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Prognostic Value of Elevated Homocysteine Levels in Korean Patients with Coronary Artery Disease: A Propensity Score Matched Analysis

  • Kwon, Sung Woo (Department of Cardiology, Inha University Hospital) ;
  • Kim, Jong-Youn (Department of Cardiology and Cardiovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Suh, Young Ju (Clinical Research Institute, Inha University School of Medicine) ;
  • Lee, Dae Hyung (Future Strategy, Inha University Hospital) ;
  • Yoon, Young Won (Department of Cardiology and Cardiovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Lee, Byoung Kwon (Department of Cardiology and Cardiovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Jung, Young-Hak (Department of Cardiology and Cardiovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Choi, Eui-Young (Department of Cardiology and Cardiovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Hong, Bum-Kee (Department of Cardiology and Cardiovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Rim, Se-Joong (Department of Cardiology and Cardiovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Kwon, Hyuck Moon (Department of Cardiology and Cardiovascular Center, Gangnam Severance Hospital, Yonsei University College of Medicine)
  • Received : 2015.09.08
  • Accepted : 2015.12.17
  • Published : 2016.03.30
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Abstract

Background and Objectives: We sought to determine whether an elevated homocysteine (Hcy) level is associated with a worse prognosis in Korean patients with coronary artery disease (CAD). Subjects and Methods: A total of 5839 patients (60.4% male, mean age $61.3{\pm}11.2years$) with CAD were enrolled from 2000 to 2010 at Gangnam Severance Hospital. CAD was diagnosed by invasive coronary angiography. Laboratory values including Hcy level were obtained on the day of coronary angiography and analyses were performed shortly after sampling. Patients were divided into two groups according to their Hcy levels. Baseline risk factors, coronary angiographic findings, length of follow-up, and composite endpoints including cardiac death (CD) and non-fatal myocardial infarction (NFMI) were recorded. 1:1 propensity score matched analysis was also performed. Results: Over a mean follow-up period of $4.4{\pm}2.5years$, there were 132 composite endpoints (75 CD and 57 NFMI) with an event rate of 2.3%. Mean Hcy level was $9.9{\pm}4.3{\mu}mol/L$ (normal Hcy $7.9{\pm}1.5{\mu}mol/L$ and elevated Hcy $13.9{\pm}5.1{\mu}mol/L$). Kaplan-Meier survival analysis showed an association of elevated Hcy level with worse prognosis (p<0.0001). In addition, a multivariate Cox regression analysis showed an association of elevated Hcy level with worse prognosis for both the entire cohort (hazard ratio [HR] 2.077, 95% confidence interval [CI] 1.467-2.941, p<0.0001) and the propensity score matched cohort (HR 1.982, 95% CI 1.305-3.009, p=0.001). Conclusion: Elevated Hcy level is associated with worse outcomes in Korean patients with CAD.

Keywords

Acknowledgement

Supported by : Inha University Hospital

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