Elsevier

American Heart Journal

Volume 140, Issue 2, August 2000, Pages 272-278
American Heart Journal

Interventional Cardiology
Homocysteine, lipoprotein(a), and restenosis after percutaneous transluminal coronary angioplasty: A prospective study,☆☆

https://doi.org/10.1067/mhj.2000.107546Get rights and content

Abstract

Background Restenosis complicates 30% to 40% of angioplasty procedures and may be unrelated to traditional coronary risk factors. Homocysteine, lipoprotein(a), and methylenetetrahydrofolate reductase (MTHFR 677T) (a genetic determinant of plasma homocysteine concentrations) are novel risk factors for coronary artery disease. Their roles in restenosis are unclear, and the potential synergism between homocysteine and lipoprotein(a) has not previously been studied. The objective of this study was to determine the relations among homocysteine, lipoprotein (a), MTHFR 677T, and restenosis after percutaneous transluminal coronary angioplasty. Methods This prospective study enrolled patients with successful elective percutaneous transluminal coronary angioplasty or stenting of a single, de novo, native coronary lesion. Fasting blood was drawn the morning of the procedure for homocysteine, lipoprotein(a), and MTHFR 677T. Follow-up angiography was performed 6 months after the procedure or earlier if clinically indicated. All cineangiograms were analyzed quantitatively. Results A total of 144 (92%) of 156 eligible patients underwent follow-up coronary angiography. The overall angiographic restenosis rate (residual stenosis >50%) was 31%. Mean homocysteine concentration was 10.1 ± 3.7 μmol/L. Plasma homocysteine concentrations were not significantly different in patients with or without angiographic restenosis (9.6 ± 3.3 vs 10.3 ± 3.8 μmol/L; P =.31). Mean lipoprotein(a) concentration was 21.2 ± 20.1 mg/dL. Plasma lipoprotein(a) concentrations were not significantly different in patients with or without restenosis (21.9 ± 21.8 vs 20.9 ± 19.5 mg/dL). Homozygosity for MTHFR 677T was present in 6.5% and was not associated with increased restenosis. No interaction between homocysteine and lipoprotein(a) was detected. Conclusions Homocysteine, lipoprotein(a), and MTHFR 677T are not associated with restenosis after percutaneous transluminal coronary angioplasty. (Am Heart J 2000;140:272-8.)

Section snippets

Methods

In this single-center, prospective study, 159 patients were enrolled from January 1994 to April 1997. This study was part of an overall effort at this institution to identify novel risk factors for restenosis.19 The study protocol was approved by the hospital ethics board, and all patients gave informed consent. Inclusion criteria were successful elective PTCA or stenting of a single de novo lesion in a native coronary artery. Exclusion criteria included recent (<2 weeks) myocardial infarction

Clinical results

Patient characteristics are illustrated in Table I.

. Baseline patient characteristics

Age56 ± 10 y
Sex (% male)77%
Diabetes18%
Hypertension44%
Previous MI26%
Smoker39%
LAD lesion58%
RCA lesion20%
Cx lesion22%

MI, Myocardial infarction; LAD, left anterior descending artery; RCA, right coronary artery; Cx, circumflex artery.

. Mean plasma concentration by quartile

Quartile1234Overall
Homocysteine (μmol/L)6.6 ± 0.98.7 ± 0.510.4 ± 0.514.6 ± 4.110.1 ± 3.7
Lipoprotein(a) (mg/dL)2.4 ± 1.39.3 ± 3.022.5 ± 4.950.5 ± 15.2

Discussion

The principal finding of this prospective study is that plasma concentrations of homocysteine and lipoprotein(a) and homozygosity for MTHFR 677T are not associated with angiographic restenosis after PTCA. Restenosis is a poorly defined process that complicates 30% to 40% of PTCA procedures.1 Thrombus incorporation, intimal hypertrophy, oxidative stress, and vascular remodeling have all been implicated as potential mechanisms.24 In particular, smooth muscle cell accumulation and proliferation

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    Supported by the Heart and Stroke Foundation of Ontario.

    ☆☆

    Reprint requests: Bradley H. Strauss, MD, PhD, Terrence Donnelly Heart Centre, Division of Cardiology, St Michael’s Hospital, 30 Bond St, Toronto, Ontario M5B 1W8, Canada. E-mail: [email protected]

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