Correlation Between Homocysteine Level And Acute Coronary Syndrome And Coronary Artery Disease

Objective:To investigate the correlation of homocysteien level with acute coronary syndrome and coronary artery lesion,so as to provide evidence for clinical prediction of occurrence and the patients assessment of acute coronary syndrome.Methods:From June 2017 to January 2018,232 patients(146 cases of male,86 cases of female)with suspected of coronary heart disease who performed informed consent and underwent coronary angiography were selected from Department of Cardiology of Kunming First People’s Hospital.Record the general information such as sex,age,history of smoking,height and weight,history of hypertension or diabetes etc when the patient was admitted.We need to dynamically dedect the markers of myocardial injury after admission.The morning venous blood was collected to detect the liver and kidney functions,blood glucose,blood routine;lipids,serum Hcy ect.Any of the coronary artery with more than 50%stenosis was diagnosed as coronary heart disease,and then the Gensini score was calculated.All the subjects were divided into coronary heart disease group(121 cases of male,71 cases of female)and non coronary heart disease group(25 cases of male,15 cases of female).The differences in related indicators between these two groups were compared and analyzed.Patients diagnosed as coronary heart disease were divided into stable angina pectoris group(25 cases of male,22 cases of female),unstable angina pectoris group(28 cases of male,27 cases of female),non ST elevation myocardial infarction group(34 cases of male,13 cases of female)and ST segment elevation myocardial infarction group(95 cases of male,50 cases of female),and the latter three groups were classified as acute coronary syndromes group(95 cases of male,50 cases of female).The difference of serum Hcy level between each group was analyzed.According to the Gensini score,the acute coronary syndrome group was divided into low score group(≤41 score),middle score group(42-96score)and high score group(>96score).The acute coronary syndrome group was also divided into single branch group(37 cases),double branch group(41 cases)and multiple branch group(67cases)according to the the number of coronary artery lesions.The relationship between serum Hcy level and coronary artery disease was analyzed.The software SPSS 19.0 was used for statistical treatment,and the difference was statistically significant when P value was less than 0.05.Results:1.There was no significant difference in age,gender,smoking history,hypertension history,diabetes history,systolic blood pressure(SBP),diastolic blood pressure(DBP),body mass index(BMI),fasting plasma glucose(FPG),total cholesterol(TC)and triglyceride(TG),low density cholesterol(LDL-C)and uric acid(UA)between non coronary heart disease group and coronary heart disease group(P>0.05).Non coronary heart disease group and coronary heart disease group had significant difference among high density lipoprotein cholesterol(HDL-C)and blood homocysteine(Hcy)(P<0.05).2.According to the results of the general information,taking HDL-C and Hcy as independent variables and coronary heart disease as a dependent variable,the logistic regression analysis showed that there was statistical difference in Hcy,it was a risk factor for coronary heart disease(OR=1.140,P=0.003<0.05),HDL-C was a protective factor for coronary heart disease(OR=0.729,P=0.027).3.The serum Hcy level in group SAP(13.98±5.94,u mol/L)was higher than that in the non coronary heart disease group(10.68±3.27,u mol/L).The serum Hcy level in group ACS(16.16±9.76 μmol/L)was higher than that in SAP group,and here was a significant difference among these three groups in serum Hcy level(F=7.120,P=0.001<0.01).The further multiple comparisons showed that there was a significant difference in serum Hey level between the non coronary heart disease group and the ACS group(P<0.05).The level of serum Hcy in each subgroup of ACS was compared.The serum Hey level in group STEMI(18.21 ±8.35 μ mol/L)is higher than that in group NSTEDMI(16.94±7.21 μ mol/L),the serum Hcy level in group NSTEMI is higher than that in the group UA(13.26±11.42 μ mol/L),and there was a significant difference among these three groups in serum Hcy level(F=6.281,P=0.023<0.05).The further multiple comparisons showed that there was a significant difference in serum Hcy level between one of these three subgroup and the others(P<0.05).4.In the group of ACS,the serum Hcy level in group of Gensini score in low(13.02±4.87 μ mol/L)was less than that in group of Gensini score in middle(17.35±13.23/μ mol/L);and the serum Hcy level in group of Gensini score in middle was less than that in the group of Gensini score in high(17.98±8.57/μmol/L),and there was a significant difference among these three groups in serum Hcy level(F=3.785,P=0.025<0.05).The further multiple comparisons showed that there was a significant difference in serum Hey level between both of the group of Gensini score in middle and the group of Gensini score in high and the group of Gensini score in low(P<0.05).The Pearson correlation analysis and the Scatter plot showed that serum Hcy level was positively correlated with Gensini score in ACS group(r2=0.173,P=0.037).5.In the ACS group,the serum Hcy level in the single branch group(13.76±10.39/μ mol/L)was less than that in double branch group(14.93±11.31/μ mol/L),and the serum Hcy level in the double branch group was less than that in multiple branch group(18.24±7.93/μ mol/L),and there was a significant difference among these three groups in serum Hcy level(F=3.053,P=0.039<0.05).The further multiple comparisons showed that there was a significant difference in serum Hey level between multiple branch group and single branch group(P<0.05).The pearson correlation analysis showed that,in the ACS group,the serum Hcy level was positively correlated with the branches of coronary artery disease(r2=0.050,P=0.0065).Conclusions:1.Elevated serum Hcy may be a risk factor for coronary heart disease.2.The serum Hey is probably associated with the occurrence and the clinical typing of the acute coronary syndrome.3.The serum Hcy level in patients with acute coronary syndrome is positively correlated with it’s severity of coronary artery disease(Gensini score)and the branches of coronary artery disease.