# Intermediate-Term Prognostic Value of Homocysteine in Acute Coronary Syndrome Complicated with or without Hypertension: A Multicenter Observational Cohort Study

## TL;DR

High homocysteine levels predict worse outcomes in heart attack patients, regardless of whether they have high blood pressure.

## Contribution

Shows homocysteine is a consistent predictor of mortality in ACS patients, irrespective of hypertension status.

## Key findings

- Elevated homocysteine levels were linked to higher mortality in both hypertensive and nonhypertensive ACS patients.
- Kaplan-Meier analysis showed lower survival in high homocysteine groups across both blood pressure categories.
- Multivariate analysis confirmed homocysteine as a significant predictor of intermediate-term mortality in ACS.

## Abstract

As a classical biomarker associated with
hypertension, the prognostic value of homocysteine (Hcy) in the intermediate-term
outcome of acute coronary syndrome (ACS) remains controversial. This study aimed
to investigate the role of homocysteine in ACS patients with different blood
pressure statuses.

A total of 1288 ACS patients from 11 general
hospitals in Chengdu, China, from June 2015 to December 2019 were consecutively
included in this observational study. The primary endpoint was defined as
all-cause death. Secondary endpoints included cardiac death, nonfatal myocardial
infarction (MI), unplanned revascularization and nonfatal stroke. The patients in
the hypertension group (n = 788) were further stratified into
hyperhomocysteinemia (H-Hcy, n = 245) and normal homocysteinaemia subgroups
(N-Hcy, n = 543) around the cut-off value of 16.81 µmol/L.
Similarly, the nonhypertensive patients were stratified into H-Hcy (n = 200) and
N-Hcy subgroups (n = 300) around the optimal cut-off value of 14.00
µmol/L. The outcomes were compared between groups.

The median follow-up duration was 18 months. During this period, 78 (6.05%)
deaths were recorded. Kaplan‒Meier curves illustrated that H-Hcy had a lower
survival probability than N-Hcy in both hypertension and nonhypertension
groups (p
< 0.01). Multivariate Cox regression analysis revealed that
H-Hcy was a predictor of intermediate-term mortality in ACS, regardless of blood
pressure status.

Elevated Hcy levels predict
intermediate-term all-cause mortality in ACS regardless of blood pressure status.
This association could be conducive to risk stratification of ACS.

The study was registered in the Chinese
Clinical Trials Registry in China (ChiCTR1900025138).