Hyperhomocysteinaemia and adverse events complicating coronary catheter interventions

Background: Since hyperhomocysteinaemia is an independent risk factor for d evelopment of atherosclerosis as well as for arterial and venous thrombosis we investigated whether elevated homocysteine levels are associated with p rocedural excess risk which complicates coronary interventions including co ronary angioplasty (PTCA), stenting, or directional coronary atherectomy (D CA). Design: Consecutive cases receiving coronary catheter interventions. S etting. Tertiary referral centre in Germany. Methods: Fasting total plasma homocysteine levels (tHcy) were determined in 648 consecutive coronary arte ry disease patients who underwent catheter interventions (272 PTCA, 102 DCA , and 274 stenting). Hyperhomocysteinaemia was defined as tHcy greater than or equal to 15 mu mol/l. The patients were investigated for a 30-day compo site endpoint, including need for target-vessel revascularization, myocardi al infarction, and death. Results: Among the 648 patients, 78 (12%) demonst rated elevated tHcy levels. The composite endpoint occurred in 41 patients (6.3%). For the entire intervention group there was no evidence that hyperh omocysteinaemia was associated with excess procedural risk (odds ratio [OR] : 1.27; 95% confidence interval [CI]=0.52 to -3.13; P=0.62). In further ana lyses according to device, hyperhomocysteinaemia also failed to predict com plications in the device related subgroups. Conclusion: The results indicat e that hyperhomocysteinaemia is not a major risk factor for 30-day adverse events complicating PTCA, DCA, or stenting. (C) 2000 Elsevier Science Irela nd Ltd. All rights reserved.