Significance of Hyperhomocysteinemia as a Risk Factor for Adverse Cardiac Outcome in Korean Patients with Coronary Artery Disease

초록

Objectives We sought to evaluate whether hyperhomocysteinemia is associated with adverse cardiac outcome in Korean patients with coronary artery disease (CAD). Methods 5839 patients (60.4% male, mean age 61.3 ±11.2 years) with CAD were enrolled from 2000 to 2010 at Gangnam Severance Hospital. CAD was diagnosed by invasive coronary angiography. Laboratory values including homocysteine level were obtained at the day of coronary angiography and analyses were done shortly after sampling. Patients were divided into two groups according to their homocysteine levels. Baseline risk factors, coronary angiographic findings, length of follow-up, and major adverse cardiovascular event (MACE) including cardiac death and non-fatal myocardial infarction (MI) were recorded. Results Over a mean follow-up period of 4.4 ± 2.5 years, there were 132 MACEs (75 cardiac death and 57 non-fatal MI) with an event rate of 2.3%. Mean homocysteine level was 9.9 ± 4.3 mg/dl (lower two tertiles 7.9 ± 1.5 mg/dl and upper tertile 13.9 ± 5.1 mg/dl). Kaplan-Meier survival analysis revealed that hyperhomocysteinemia was associated with adverse cardiac outcome (p < 0.0001). Furthermore, multi-variate Cox regression analysis after adjustment of age, diabetes, hypertension, revascularization and extent of CAD revealed that hyperhomocysteinemia was associated with worse prognosis [HR 1.884, 95% CI 1.327-2.675 (p < 0.0001)]. Conclusions In terms of prognosis, hyperhomocysteinemia is associated with adverse cardiac outcome in Korean patients with CAD.