Interventional CardiologyHomocysteine, lipoprotein(a), and restenosis after percutaneous transluminal coronary angioplasty: A prospective study☆,☆☆
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. MI, Myocardial infarction; LAD, left anterior descending artery; RCA, right coronary artery; Cx, circumflex artery.Age 56 ± 10 y Sex (% male) 77% Diabetes 18% Hypertension 44% Previous MI 26% Smoker 39% LAD lesion 58% RCA lesion 20% Cx lesion 22% Quartile 1 2 3 4 Overall Homocysteine (μmol/L) 6.6 ± 0.9 8.7 ± 0.5 10.4 ± 0.5 14.6 ± 4.1 10.1 ± 3.7 Lipoprotein(a) (mg/dL) 2.4 ± 1.3 9.3 ± 3.0 22.5 ± 4.9 50.5 ± 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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The role of oxidized phospholipids, lipoprotein (a) and biomarkers of oxidized lipoproteins in chronically occluded coronary arteries in sudden cardiac death and following successful percutaneous revascularization
2012, Cardiovascular Revascularization MedicineCitation Excerpt :The control group was derived from a single-center prospective study of 141 patients, recruited from January 1994 to January 1997, with stable angina undergoing elective uncomplicated PCI to a non-CTO vessel. This cohort has been previously described in detail [21,22] and the OxPL and OxLDL biomarker data used in our study for comparison purposes were published previously [16]. As patient recruitment for this study was performed in the mid to late 1990s, most patients underwent balloon angioplasty with adjunctive stenting reserved for suboptimal balloon angioplasty results and/or the presence of significant (type C or greater) dissections (41 patients, 29%).
Prevalence of methylenetetrahydrofolate reductase C677T and A1298C polymorphisms in Taiwanese patients with Type 2 diabetic mellitus
2011, Clinical BiochemistryCitation Excerpt :No significant difference of MTHFR A1298C genotypes (p = 0.26) and alleles (p = 0.21) distribution between diabetic patients and control individuals was found. In diabetic patients, Hcy increases significantly with age and males have higher Hcy levels than females [18]. Therefore, the association between gender and MTHFR genotypes was subsequently analyzed (Table 3).
Prognostic Value of Plasma Fibrinolysis Activation Markers in Cardiovascular Disease
2010, Journal of the American College of CardiologyCitation Excerpt :In 397 patients undergoing coronary angiography, high Lp(a) levels were independently associated with the presence of coronary obstruction (OR: 2.5) (69). Yet, in patients undergoing PCI with angiographic follow-up, plasma Lp(a) concentrations were not predictive of restenosis (70). Recently the first meta-analysis of long-term prospective studies investigating Lp(a) published over the last 40 years, involving nearly 127,000 subjects, was reported.
Relationship of a comprehensive panel of plasma oxidized low-density lipoprotein markers to angiographic restenosis in patients undergoing percutaneous coronary intervention for stable angina
2005, American Heart JournalCitation Excerpt :Despite significant changes in several OxLDL markers, particularly post-PCI, no differences existed between patients with and without restenosis as well as with quantitative and qualitative angiographic parameters. Earlier data have also suggested that Lp(a) predicted restenosis, but recent studies with improved study designs have shown no relationship in both balloon angioplasty and stent cohorts.19,26-29 This is extended in this study by showing that Lp(a) levels at baseline and serially up to 6 months do not predict restenosis, despite the fact that the mean percent change in Lp(a) levels increased significantly post-PCI.
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Supported by the Heart and Stroke Foundation of Ontario.
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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]