Effects Of Homocysteine On In-stent Restenosis And Long-term Prognosis In Patients With Acute Coronary Syndromes After PCI

[Objective]Cardiovascular disease has become the first cause of death in domestic residents,and coronary heart disease incidence is rising,and the incidence was younger state of affairs.The burden of prevention of coronary heart disease is increasing.Therefore it has become a major public health problem.A large number of animal experiments and clinical trials have demonstrated plasma homocysteine(Hcy)levels and coronary heart disease are closely correlated.This study will examine the effects of plasma Hcy on in-stent restenosis(ISR)and major adverse cardiovascular events(MACE)after drug-eluting stents implanted in patients with acute coronary syndromes(ACS).[Methods]1.A total of 295 ACS patients were enrolled in the Second Affiliated Hospital of Suzhou University from July 2014 to April 2014,and 289 patients were followed-up.There were 130 patients with unstable angina pectoris,76 patients with non-ST segment elevated myocardial,83 patients with ST-segment elevation myocardial infarction,the patients who hospitalized were all implanted with drug-eluting stents.2.Patients with Hcy ? 15?mol/L were defined as high Hcy group and patients with Hcy <15?mol / L were defined as low Hcy group.3.Collectting the past history of the patient,blood biochemical parameters,recording the results of coronary intervention.4.The stent implantation was followed up for 12 months.MACE will be recorded as the endpoint and,The blood samples were collected again from the patients at the last follow-up.During the period of 134 patients completed coronary angiography review,the results of coronary angiography were recorded.5.The effect of plasma Hcy level on ISR and MACE in stent implantation was evaluated by multivariate Cox regression.[Results]1.289 cases of patients with acute coronary syndrome,patients with high Hcy group accounted for 47.1%,Hcy an average concentration of 23.60 ± 5.76mmol/L,and patients with low Hcy group accounted for 52.9%,the average concentration of Hcy was 11.56 ± 3.43mmol/L.Samples mean concentration of plasma Hcy 17.85 ± 4.61mmol/L.2.A total of 134 patients underwent coronary angiography in 12 months,14 of whom had ISR.The incidence of ISR in the high Hcy group was significantly higher than that in the low Hcy group(P = 0.037).3.All patients were followed up for 12 months and 39 patients had MACE.The incidence of MACE in the high Hcy group was higher than that in the low Hcy group(P <0.001).The high Hcy group had higher target vessel revascularization rate(P = 0.048).4.Multivariate Cox regression analysis showed that Hcy was an independent predictor of ISR and MACE after drug-eluting stents implantation in ACS patients(P= 0.003;P = 0.002).[Conclusions]1.The mean plasma Hcy concentration in ACS patients was higher.2.With the increase of plasma Hcy concentration,the incidence of ISR and MACE was increased in ACS patients after implantation of drug-eluting stents.3.High concentration of Hcy is an independent risk factor for ISR and MACE afterimplantation of drug-eluting stents in patients with acute coronary syndromes.