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Heart 2001;85:380-384; doi:10.1136/heart.85.4.380
Copyright © 2001 BMJ Publishing Group Ltd & British Cardiovascular Society
Heart 2001;85:380-384 ( April )

Cardiovascular medicine

Acute and convalescent changes in plasma homocysteine concentrations in acute coronary syndromes M K Al-Obaidi, P J Stubbs, R Amersey, M I M Noble

National Heart and Lung Institute, Charing Cross Campus, Imperial College School of Medicine, and the Cardiology Department of The Hammersmith Hospitals NHS Trust, London, UK

Correspondence to: Dr M Al-Obaidi, National Heart and Lung Institute, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK m.al-obaidi{at}rbh.nthames.nhs.uk

Accepted 13 December 2000

BACKGROUND---Raised plasma homocysteine is a risk factor for coronary artery disease. Patients with myocardial infarction or unstable angina show greater activation of coagulation, greater troponin release, and a worse outcome.
OBJECTIVE---To examine variations in plasma homocysteine concentration in relation to C reactive protein (CRP) in patients presenting with acute coronary syndromes.
METHODS---Consecutive patients presenting with acute myocardial infarction (22) and unstable angina pectoris (12) were studied. Plasma samples were obtained on admission (before clinical intervention), on days 2, 7, and 28, and again six months after admission. Plasma homocysteine, assayed by high performance liquid chromatography, and CRP were both determined at the same time points. Changes were assessed by analysis of variance.
RESULTS---CRP concentrations showed a classical rise on day 2, followed by a gradual decline to normal values taken at six months from admission in both myocardial infarction (p < 0.0001) and unstable angina (p = 0.02). Homocysteine concentrations in myocardial infarction (median, 25th to 75th interquartile range) were: 11.9 (10.7 to 12.6), 11.5 (9.1 to 13.4), 12.1 (11.4 to 14.1), 12.4 (11.1 to 14.4), and 12.1 (11.2 to 14.0) µmol/l, for days 1, 2, 7, 28, and 180, respectively (p = 0.02). Significant differences were observed only between day 2 and day 7 (p < 0.05). The final homocysteine measurement was not different from the admission level. Homocysteine concentrations in unstable angina did not differ between admission and convalescence (12.5 (9.1 to 14.5) µmol/l and 12.3 (7.7 to 14.9) µmol/l, respectively).
CONCLUSIONS---Plasma homocysteine concentrations are minimally influenced by acute phase variations with reliable measurements obtained on admission in patients with myocardial infarction and unstable angina.


Keywords: myocardial infarction; unstable angina; homocysteine; sample timing

© 2001 by Heart
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