Blood homocysteine levels could predict major adverse cardiac events in patients with acute coronary syndrome: A STROBE-compliant observational study.

Abstract	The Global Registry of Acute Coronary Events (GRACE) risk score independently predicts major adverse cardiac events (MACEs) in patients with acute coronary syndrome (ACS). This study aims to evaluate whether the level of plasma homocysteine in addition to the GRACE score enhances the predictive value for MACEs in patients with acute coronary syndrome.A total of 361 patients with ACS evaluated at our hospital were included in the study and tested for blood homocysteine levels. We recorded 40 (11.1%) instances of MACE during a median follow-up of 43.3 months (quartile 40.6-44.4 months), including 29 cases (8.0%) of all-cause death and 11 cases (3.1%) of nonfatal myocardial infarction.The GRACE score was significantly associated with homocysteine levels, and multivariate Cox regression analysis showed that both the GRACE risk score and homocysteine content were independent predictors of MACEs (HR 2.63; 95% confidence interval (CI) 1.54 to 4.49; P < .001 and 2.27; 1.06 to 4.86; P = .035, respectively). Moreover, meta-analysis showed that as the homocysteine level increased, the incidence of MACEs also increased (log-rank 8.41; P = .015). GRACE scores adjusted by homocysteine level increased the area under the curve (AUC) from 0.78 to 0.83 (P = 0.006).Blood homocysteine levels are significantly associated with the GRACE risk score, and using both parameters can further improve risk stratification in patients with acute coronary syndrome.
Authors	Jianlin Liu, Jianjun Quan, Yanzi Li, Yue Wu, Lin Yang
Journal	Medicine (Medicine (Baltimore)) Vol. 97 Issue 40 Pg. e12626 (Oct 2018) ISSN: 1536-5964 [Electronic] United States
PMID	30290636 (Publication Type: Journal Article, Observational Study)
Chemical References	Biomarkers Homocysteine
Topics	Acute Coronary Syndrome (blood, epidemiology) Age Factors Aged Biomarkers Body Mass Index Comorbidity Female Health Status Indicators Hematologic Tests Homocysteine (blood) Humans Male Middle Aged Myocardial Infarction (epidemiology) ROC Curve Risk Assessment Risk Factors

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