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Acute and convalescent changes in plasma homocysteine concentrations in acute coronary syndromes
  1. M K Al-Obaidi,
  2. P J Stubbs,
  3. R Amersey,
  4. M I M Noble
  1. 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
  1. Dr M Al-Obaidi, National Heart and Lung Institute, Royal Brompton Hospital, Sydney Street, London SW3 6NP,{at}


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.

  • myocardial infarction
  • unstable angina
  • homocysteine
  • sample timing

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