Effect of hyperhomocysteine in patients after PCI for non-ST-segment elevation myocardial infarction, a retrospective study

Effect of hyperhomocysteine in patients after PCI for non-ST-segment elevation myocardial infarction, a retrospective study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of hyperhomocysteine in patients after PCI for non-ST-segment elevation myocardial infarction, a retrospective study Kai Lan, Hui Gong This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4185370/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The prognostic value of homocysteine (HCY) in patients with coronary artery disease (CAD) remains controversial. The aim of this study was to investigate whether an elevated HCY level on admission can predict long-term outcomes in patients with Non-ST-Segment elevation myocardial infarction (NSTEMI) after percutaneous coronary intervention (PCI) with coronary artery stenting. Methods From Jinshan Hospital Affiliated to Fudan University from January 2018 to December 2021, 275 patients who were diagnosed with NSTEMI and successfully underwent emergency PCI were conducted. All these patients were divided into two groups according to fasting plasma HCY levels the day after the theterization: group Ⅰ (142 patients, <15 µmol/L) and group II (127 patients, ≥ 15 µmol/L).Primary and secondary outcome measures: The primary endpoint was the occurrence of major adverse cardiac events (MACE), including cardiac death, non-fatal myocardial infarction, stroke, and new lesion stenting. Results After a mean follow-up of 36 ± 14 months, patients in group II had a higher rate of MACE (33.9% vs. 17.6%, p = 0.002). The main difference between the two groups was cardiac death (8.7% vs. 2.1%, p = 0.016). The risk of long-term MACE remained significantly higher in patients with elevated HCY levels (≥ 15 µmol/L) with a hazard ratio of 1.29 (95% CI, 1.1-12.23, p = 0.034). Elevated HCY levels (≥ 15 µmol/L) were independently associated with an increased risk of long-term cardiovascular events in patients after PCI. Conclusion Thus, hyperhomocysteinemia may remain a useful prognostic marker for risk assessment in the clinical management of CAD patients. non-ST-segment elevation myocardial infarction percutaneous coronary intervention homocysteine Figures Figure 1 Figure 2 Introduction Cardiovascular disease is a prominent contributor to mortality worldwide and is responsible for over 30% of the global annual fatality rate.[ 1 ]The incidence of total cardiovascular disease cases almost doubled from 271 million in 1990 to 523 million by 2019, and the mortality of cardiovascular diseases significantly increased from 12.1 million in 1990, reaching 18.6 million in 2019.[ 2 ] Coronary artery disease is becoming increasingly common worldwide and is the leading cause of death from cardiovascular diseases. In China, Acute Coronary Syndrome (ACS) accounts for 50% of cardiovascular disease mortality and is the most common form of coronary heart disease.[ 3 ] Several studies have shown that myocardial revascularization by percutaneous coronary intervention (PCI )more effectively relieves angina, reduces the use of anti-anginal drugs, and improves exercise capacity and quality of life compared with a strategy of medical therapy alone during short- and long-term follow-up.[ 4 – 6 ] Homocysteine (Hcy) is a non-essential amino acid that can cause endothelial damage, which is the starting point of atherosclerosis.[ 7 ] Elevated serum Hcy increases oxidative stress and stimulates the proliferation of vascular smooth muscle cells, thereby increasing the risk of atherosclerosis.[ 8 ] Homocysteine, as an independent risk factor for coronary artery disease, not only contributes to the development of ACS through a variety of means, but also affects the prognosis of patients undergoing percutaneous coronary intervention for ACS. A recent study showed serum Hcy concentrations was positively correlated with the prevalence of vascular sclerosis.[ 9 ]Some study were concentrating on the relationship between homocysteine and stent restenosis[ 10 , 11 ]. However, studies have assessed the predictive value of serum HCY in patients with ST-segment elevation myocardial infarction (STEMI).[ 12 ] There are few studies on the effect of high Hcy level on the prognosis of patients undergoing percutaneous coronary intervention in the emergency setting of non-ST-segment elevation myocardial infarction (NSTEMI), especially in Asian populations. Therefore, in this study, patients undergoing emergency PCI for NSTEMI were divided into two groups according to homocysteine, and the occurrence of adverse events were analyzed to determine the effect of Hcy level on the prognosis of the patients. Methods Patients In this retrospective study, collected from Jinshan Hospital Affiliated to Fudan University from January 2018 to December 2021 diagnosed as NSTEMI and successfully performed an emergency PCI 280 patients were treated. The inclusion criteria included if the patient fulfills 2 of the following 3 standards: 1)Chest pain lasting at least half an hour or more, consistent with chest pain from a heart attack 2༉elevated concentration of a circulating marker of myocardial necrosis cardiac troponin I (cTnI ) or creatine kinase myocardial band (CK-MB), elevated high-sensitivity troponin levels present within 3 h, serum markers of myocardial injury exceed the 99th percentile of the upper limit of normal 3༉had a dynamic evolutionary process electrocardiography are associated with ST segment depressions, T-wave inversions. The exclusion criteria were as : 1) severe hepatic or renal insufficiency; 2) suffering from severe metabolic diseases (gout, hypothyroidism); 3) severed infections; 4) advanced malignant tumors;5) hematologic diseases; 6) active ulcers and bleeding; 7) history of major surgery and trauma and other anticoagulant contraindications, contraindications to anticoagulation such as history of surgical trauma and allergy to aspirin 8) duplex antiplatelet less than 12 months after stenting 9) had taken any drugs in the past three months that affect the horizontal position of plasma HCY Data Collection Clinical data of the enrolled patients were recorded, including gender, age, blood pressure, body mass index(BMI), smoking, alcohol consumption, past medical history (hypertension, diabetes mellitus, atrial fibrillation, hyperlipidemia, chronic kidney disease), dyslipidemia, relevant laboratory test results, coronary artery lesions and interventions (location of lesions, number of lesions, number of stents), all-cause mortality and major adverse cardiovascular events (MACEs) after PCI, including cardiac death, nonfatal myocardial infarction and angina and unplanned revascularization were recorded. The next day, fasting blood was drawn from the elbow and sent to the laboratory for hematological analysis. Heart rates and blood pressure were measured when were hospitalized by nurse. The following definitions were used: hypertension,blood pressure ≥ 140/90mmHg or antihypertensive treatment; hypercholesterolemia, total cholesterol > 200mg/dL (5.2mmol/L); diabetes mellitus, fasting plasma glucose > 125mg/dL (7.0mmol/L) or glucose lowering treatment. Atrial fibrillation, diagnosed by ECG or previously diagnosed and on medication. Chronic kidney disease with abnormal function for ≥ 3 months or previously diagnosed. Cigarette smoking was defined as having smoked at least one cigarette per day or 20 packs or more in the past year. Alcohol consumption was defined as drinking alcohol at least twice per week in the past year. Patients were discharged from the hospital as the starting point for follow-up. All patients were followed by telephone, the inpatient and outpatient medical records systems. Postoperative all-cause mortality and major adverse cardiovascular events were recorded. Statistical analysis : The clinical data of the study participants were summarized and analyzed. Continuous variables were expressed as mean ± standard deviation (SD) and t-test was used for comparison between groups. Categorical variables were expressed as percentages and non-parametric comparisons between groups by using chi-square test or Fisher exact test. COX one-way analysis was performed based on the included study variables, and P less than 0.1 was included in the multifactorial COX proportional risk models. MACE-free survival curve was depicted by the Kaplan–Meier method and differences between the two groups were assessed by the log-rank test. P value less than 0.05 was considered statistically significant. Results A total of 280 patients met the eligibility criteria to be included as study participants in the registry. The final sample size was 269 due to 11 patients who were lost to interview and could not be analyzed (Fig. 1 ). Consecutive enrollment of patients (mean age 64 ± 12 years, range 32–91 years; 82.9% male) was undertaken for analysis (Table.1). The patients were categorized into two groups based on the baseline plasma total HCY level. Cut-off value of 15 µmol/L: Group 1 (142 patients, HCY < 15 µmol/L) and Group 2 (127 patients, ≥ 15 µmol/L) were compared based on their baseline characteristics, as presented in Table 1 . There was no statistical difference in BMI, heart rates, systolic blood pressure and diastolic blood pressure between the two groups. Traditional coronary risk factors, including age, hypertension, diabetes mellitus, and hypercholesterolemia were compared between groups. For personal and history, there is no statistical difference in smoking, alcoholic consumption, hypertension, diabetes, dyslipidemia, and atrial fibrillation. About laboratory test, except creatinine have statistical difference. Table 1 baseline Variables <15.0 µmol/L (n = 142) ≥ 15.0 µmol/L (n = 127) P value Male 113(79.6) 110(86.6) 0.126 Smoking, n (%) 62(43.7) 68(53.5) 0.105 Alcoholic consumption, n(%) 31(21.8) 28(22) 0.966 Diabetes, n (%) 50(35.2) 38(29.9) 0.356 Hypertension, n(%) 50(35.2) 43(33.9) 0.816 Dyslipidemia, n(%) 19(13.4) 18(14.2) 0.850 Atrial fibrillation, n(%) 11(7.7) 5(3.9) 0.187 Chronic kidney disease, n(%) 3(2.1) 12(9.4) 0.009 Age (y, Mean ± SD) 62.4 ± 12.7 67.0 ± 12.69 0.004 BMI (kg/m 2 ) 24.9 ± 2.9 24.2 ± 3.2 0.057 HR 78 ± 14 79 ± 17 0.573 Systolic blood pressure(mmHg) 132 ± 20 131 ± 25 0.972 Diastolic pressure (mmHg) 79 ± 13 78 ± 14 0.257 Hemoglobin(g/L) 133 ± 17 133 ± 16 0.904 Platelet(10 ˄9 ) 202 ± 60 196 ± 53 0.371 Creatinine (umol/L) 72.8 ± 16.9 101.1 ± 59.5 < 0.001 Fasting glucose(umol/L) 7.55 ± 3.12 7.43 ± 4.68 0.803 Glycated hemoglobin(umol/L) 6.89 ± 1.53 6.60 ± 1.55 0.904 Triglyceride(umol/L) 1.94 ± 1.2 1.76 ± 1.17 0.212 Cholesterol(umol/L) 4.77 ± 1.19 4.51 ± 1.26 0.084 LDL cholesterol(mg/dl) 3.14 ± 0.19 2.93 ± 0.93 0.062 HDL cholesterol(mg/dl) 1.01 ± 0.19 0.98 ± 0.21 0.319 Peak Myoglobin(ng/dL) 265 ± 197 329 ± 387 0.600 Peak cTnI (ng/dL) 10.26 ± 9.93 10.87 ± 11.28 0.639 Peak CK-MB (ng/dL) 47.79 ± 53.88 42.89 ± 32.60 0.382 Left main,n (%) 1(0.7) 3(2.4) 0.262 LAD,n (%) 56(39.4) 38(29.9) 0.102 LCX, n (%) 42(29.6) 45(35.4) 0.305 RCA, n (%) 37(26.1) 35(27.6) 0.781 Graft, n (%) 6(4.2) 6(4.7) 0.843 history of PCI, n (%) 23(16.2) 27(21.3) 0.287 Lesion length, (mm) 2.72 ± 0.47 2.70 ± 0.47 0.645 Stent size, (mm) 21.86 ± 5.97 22.16 ± 5.99 0.683 Number of stents per lesion(mm) 1.27 ± 0.51 1.27 ± 0.58 0.999 LAD: left anterior descending LCX: left circumflex RCA: right coronary artery No correlation was observed between in hemoglobin, platelets, fasting plasma glucose, glycated hemoglobin, triglycerides, total cholesterol, triglycerides, LDL-c,HDL-c .In addition, peak myoglobin, peak cTnI and peak CK-MB were not significantly different between the two groups and were all above normal standards. As for coronary artery lesions and interventions there was no significant difference in lesion location, history of PCI between the two groups. Furthermore, there was no significant difference in the sizes and lengths of the implanted coronary artery stents between the two groups. The number of stents per lesion has no differences. (Table 1 ) Long-Term Clinical Outcomes: A total of 269 patients, who survived and discharged from hospital after PCI, were followed up for a mean of 36 ± 14 months. The patients in group Ⅱ had a significantly higher mortality rate than those in group Ⅰ (8.7% vs. 2.1%, p = 0.016) and all of them were from cardiac death. In addition, the group Ⅱ patients had a higher MACE rate than group Ⅰ patients (33.9% vs. 17.6%, p = 0.002) (Table 2 ). However, people with non-fatal MI, new lesion stenting, non-fatal stroke has no significant difference between two groups. In Kaplan–Meier analysis, there was a significant difference in the MACE-free survival rate between the two groups (log-rank test; p = 0.022) (Figure.2). Table 2 Clinical events during long-term follow-up <15.0 µmol/L (n = 142) ≥ 15.0 µmol/L (n = 127) P value Number of patients 142 127 Cardiac death, n (%) 3(2.1) 11(8.7) 0.016 Non-fatal MI, n (%) 2 (1.4) 7(5.5) 0.062 New lesion stenting, n (%) 13(9.2) 11(8.7) 0.887 Non-fatal stroke, n (%) 5(3.5) 8(6.3) 0.289 MACE, n (%) 25(17.6) 43(33.9) 0.002 According to the univariate Cox proportional hazards analysis, the MACE rates were significantly associated with age and plasma HCY levels ≥ 15 µmol/L. After adjusting for age, gender, hypertension, diabetes mellitus, hyperlipidemia, serum creatinine, HCY levels ≥ 15 µmol/L, creatinine, history of PCI, number of stents per lesion, smoking, alcoholic history, and BMI, only age remained as a statistically significant predictor for long-term cardiovascular outcomes, with a HR of 1.97 (95% CI: 1.14–3.39, p = 0.014). (Table 3 ) Table 3 Cox Proportional Cox Proportional Hazards Regression Univariate Multivariate Predictors HR 95%CI P value HR 95%CI P value Homocysteine (≥ 15.0 µmol/L) 3.968 1.10-12.23 0.034 2.417 0.57–10.21 0.230 Female 0.553 0.17–1.76 0.316 0.894 0.22–3.57 0.875 Diabetes mellitus 0.569 0.15–2.04 0.386 0.353 0.07–1.62 0.182 Hypertension 1.261 0.39–4.02 0.695 0.994 0.28–3.50 0.992 Hyperlipidemia 1.182 0.26–5.30 0.827 2.130 0.40–11.10 0.370 Creatinine 1.004 0.99–1.01 0.350 1.003 0.99–1.01 0.650 history of PCI 1.003 0.27–3.61 0.996 0.913 0.24–3.45 0.893 Number of stents per lesion 1.790 0.87–3.64 0.109 1.998 0.24–3.45 0.118 Age(every 10 years) 2.281 1.36–3.82 0.002 1.973 1.14–3.39 0.014 Smoking 0.467 0.14–1.49 0.199 0.270 0.06–1.20 0.086 Alcoholic history 1.487 0.46–4.72 0.503 2.909 0.60-13.88 0.181 BMI 0.942 0.79–1.11 0.487 1.076 0.87–1.32 0.490 Discussion In up to a mean of 36 ± 14 months of follow-up, three main results were found in the current study. First, the mortality rate and MACE rate were significantly lower in the low homocysteine group than in the high homocysteine group. Second, the univariate Cox proportional hazards analysis, the MACE rates were significantly associated with age and plasma HCY levels ≥ 15 µmol/L. However, while after adjusting for age, gender, hypertension, diabetes mellitus, hyperlipidemia, serum creatinine, HCY levels ≥ 15 µmol/L, creatinine, history of PCI, number of stents per lesion, smoking, alcoholic history, and BMI, only age remained as a statistically significant predictor for long-term cardiovascular outcomes, with a HR of 1.97 (95% CI: 1.14–3.39, p = 0.014).Finally, in Kaplan–Meier analysis, there was a significant difference in the MACE-free survival rate between the two groups (log-rank test; p = 0.037). Many studies have now shown that hyperhomocysteinemia is an independent risk factor for coronary and cerebrovascular disease. In recent years some studies have also tried to explore the relationship between homocysteine and prognosis in coronary arteries. A study from the institutional registry of Cardiovascular Atherosclerosis and Percutaneous TrAnsluminal Interventions (CAPTAIN) enrolled 1,307 patients with documented CAD undergone PCI with bare metal stents from July 2003 to December 2014. All of the patients were divided into two groups according to fasting plasma HCY levels: group Ⅰ (883 patients, <12 µmol/L) and group II (424 patients, ≥ 12 µmol/L). After a mean follow-up period of 58 ± 41 months, the group II patients had a higher MACE rate (33.3% vs. 25.6%, p = 0.005) .Elevated HCY levels (≥ 12 µmol/L) were independently associated with an increased risk of long-term cardiovascular events in patients after coronary bare metal stent implantation.[ 13 ]In our study, mortality and MACE were higher in the group with high homocysteine levels compared to the group with normal homocysteine levels. However, their study focused on metal stents, while all of our patients received second-generation drug-eluting stents, which may also have contributed to our different results. Hcy is a sulfur-containing amino acid produced by the metabolism of methionine. It is now thought to contribute to atherosclerotic plaque formation and adverse cardiovascular events through a variety of mechanisms and adverse cardiovascular events.[ 14 ] However, the pathophysiological mechanisms were not fully understood. Basic studies have shown that high homocysteine significantly stimulates the proliferation of cultured human and porcine smooth muscle cells, while inhibiting the growth of cultured endothelial cells. Vascular injury stimulates smooth muscle proliferation, which is further enhanced by homocysteine in a dose-dependent manner.[ 15 ] Hcy is a prothrombotic disorder that may lead to oxidative endothelial damage and impair endogenous fibrinolysis.[ 16 ]In addition, Hcy also has a diastolic response to small vessels (especially in non-nitric oxide-mediated pathways), which predisposes to rupture of vulnerable plaques, leading to the progression of atherosclerosis and ultimately to atherosclerotic events. This can lead to the rupture of vulnerable plaques, leading to the progression of atherosclerosis and ultimately to cardiovascular events.[ 17 ] The extent of the association between acute myocardial infarction (AMI) and hyperhomocysteine remains unknown. In a prospective study of a Chinese population, researchers measured plasma Hcy levels in 178 patients with ST-segment elevation AMI treated with primary PCI, and ultimately found that elevated homocysteine concentrations were a significant risk factor for advanced diffuse coronary atherosclerosis in Chinese patients with acute myocardial infarction treated with primary PCI.[ 18 ] However, in many trials of Hcy-lowering treatments, such as vitamin B12 and folic acid supplements, there were no beneficial effects on cardiovascular disease prevention.[ 19 – 22 ] Therefore, vitamin B12 and folic acid supplements were not included in our study protocol.It is generally believed that infarct-related in-stent restenosis is one of the most important prognostic factors for patients with ACS after PCI, and it is also one of the major difficulties in the treatment of ACS. [ 23 ]Most studies have evaluated the effect of elevated Hcy levels on restenosis after PCI, and few studies have evaluated mortality in patients with CAD after PCI by baseline plasma Hcy levels[ 19 , 24 , 25 ]. Few studies have assessed mortality in patients with myocardial infarction after PCI by baseline plasma Hcy levels, especially in non-ST-segment elevation myocardial infarction.[ 26 ] However, the effect of homocysteine on restenosis is controversial, the present study provides evidence that elevated plasma Hcy levels have a negative impact on long-term survival in patients with PCI and that patients with elevated Hcy levels (≥ 15 mmol/L) had significantly higher mortality than those with low levels (< 15 mmol/L), after adjusting for other factors that may affect the prognosis of PCI. However regarding hyperhomocysteine and stent restenosis, a meta-analysis that included 4340 participants showed that although there was no clear association between higher Hcy levels and restenosis after stenting, higher Hcy levels appeared to increase the risk of restenosis after coronary angioplasty and increased the risk of all-cause mortality, MACE, and cardiac death after PCI.[ 10 ] J. Guo’s study about the correlation between Hcy and ISR severity found a positive correlation between homocysteine and the severity of restenosis after PCI. In addition, ROC curve analysis showed that serum Hcy level could be used as a predictive biomarker of ISR severity after PCI.[ 11 ] A number of other studies have been conducted in support of a better prognostic correlation between interventions to lower blood Hcy levels (folic acid, vitamin B6, and vitamin B12) after PCI in patients with hyperhomocysteinemia and after PCI. For example, Schnyder et al.[ 27 ] conducted a study enrolled 553 patients undergoing angioplasty and found that the primary adverse cardiac event composite endpoint was significantly lower in the intervention group than in the non-intervention group. However, some studies of the effect of elevated Hcy on PCI outcomes have reached negative conclusions; A study by Ebbing et al.[ 28 ] included 3096 patients after PCI and found no prognostic impact of Hcy after a median follow-up of 38 months. In addition, another small study by Genser et al.[ 29 ] followed 292 patients who successfully underwent PCI. At six-month follow-up, stent restenosis was not associated with Hcy levels.At six months of follow-up, stent restenosis was not associated with Hcy levels. For increased cardiac mortality in patients with hyperhomocysteinemia, a study comparing the relationship between hyperhomocysteinaemia and short-term prognosis in patients with acute myocardial infarction. Eighty-five patients were divided into two groups based on plasma Hcy levels. Gender, hypertension, diabetes mellitus, hyperlipidaemia, time from onset of symptoms to percutaneous coronary intervention, homocysteine, creatine kinase isoforms, and the incidence of 30-day adverse events were compared between the two groups. The overall incidence of adverse cardiovascular events was found to be significantly higher in the plasma Hcy group than in the comparison group, but the incidence of postprocedural angina and reinfarction was similar in all groups. They therefore concluded that elevated total plasma Hcy levels in patients with acute myocardial infarction undergoing percutaneous coronary intervention may be associated with short-term prognosis. Although this is similar to the results of our study, the short duration of this study and had a small sample size, which may have been affected by patient selection bias.[ 30 ] Similar trials have demonstrated that elevated Hcy levels in patients with AMI are independent of other risk factors and are associated with a higher incidence of coronary events.[ 31 ] The present study is in agreement with the results of most studies that high Hcy can exacerbate coronary artery disease and that serum Hcy levels had an important prognostic value for the long-term prognosis of patients with NSTEMI. This study had several limitations. First, homocysteine metabolism is also influenced by diet, and we were unable to adjust for individual differences. Second, the methylenetetrahydrofolate reductase (MTHFR) enzyme, folate, vitamin B6, and vitamin B12 are required for the metabolism of homocysteine to methionine or cysteine. However, the MTHFR C677T gene has a polymorphism associated with hyperhomocysteinaemia.[ 32 – 34 ] In our study protocol, we did not routinely measure serum folate, vitamin B12 and gene polymorphisms, which resulted in no way to understand the interaction between them in terms of risk of cardiovascular events. Third, our sample size was small, which may have led to trial bias. Therefore, we need to further increase the sample size for inclusion in the future, as well as extend the follow-up time. Finally, we did not consider the effect of drugs on homocysteine. In conclusion, serum Hcy level is an independent risk factor for adverse cardiovascular events after PCI in patients with NSTEMI. Declarations Acknowledgments ： We would like to thank the Information Department of Jinshan Hospital, Fudan University, for data retrieval and other arrangements. Authors’ contributions： GH was responsible for the idea design, statistical technical support, and content of the article. LK wrote the article. LK was responsible for part of the data analysis and language correction. LK and GH were responsible for clinical data collection, literature search, and other contributions. Funding ： None Data Availability ： The data that support the findings of this study are available from Jinshan Hospital Affiliated to Fudan University, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the corresponding author upon reasonable request and with permission of Jinshan Hospital Affiliated to Fudan University. Conflict of interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Ethics approval and consent to participate ： The studies involving human participants were reviewed and approved by Ethics Committee Approval letter of Jinshan Hospital, Fudan University. Consent for publication : Not applicable. Author details : 1. Department of Cardiology, Jinshan Hospital Affiliated to Fudan University,Shanghai201500，China. Email: [email protected] 2. Department of Cardiology, Jinshan Hospital Affiliated to Fudan University Shanghai201500，China. Email: [email protected] ORCID id:0000-0002-7833-433X References Pagidipati NJ, Gaziano TA. Estimating deaths from cardiovascular disease: a review of global methodologies of mortality measurement. Circulation. 2013;127(6):749–56. Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, Barengo NC, Beaton AZ, Benjamin EJ, Benziger CP, et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019: Update From the GBD 2019 Study. J Am Coll Cardiol. 2020;76(25):2982–3021. Liu S, Li Y, Zeng X, Wang H, Yin P, Wang L, Liu Y, Liu J, Qi J, Ran S, et al. Burden of Cardiovascular Diseases in China, 1990–2016: Findings From the 2016 Global Burden of Disease Study. JAMA Cardiol. 2019;4(4):342–52. Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, et al. : 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019;40(2):87–165. Stergiopoulos K, Brown DL. Initial coronary stent implantation with medical therapy vs medical therapy alone for stable coronary artery disease: meta-analysis of randomized controlled trials. Arch Intern Med. 2012;172(4):312–9. Katritsis DG, Ioannidis JP. Percutaneous coronary intervention versus conservative therapy in nonacute coronary artery disease: a meta-analysis. Circulation. 2005;111(22):2906–12. Christen WG, Cook NR, Van Denburgh M, Zaharris E, Albert CM, Manson JE. Effect of Combined Treatment With Folic Acid, Vitamin B(6), and Vitamin B(12) on Plasma Biomarkers of Inflammation and Endothelial Dysfunction in Women. J Am Heart Assoc 2018, 7(11). Karolczak K, Kubalczyk P, Glowacki R, Pietruszynski R, Watala C. Aldosterone modulates blood homocysteine and cholesterol in coronary artery disease patients - a possible impact on atherothrombosis? Physiol Res. 2018;67(2):197–207. Chen L, Wang B, Wang J, Ban Q, Wu H, Song Y, Zhang J, Cao J, Zhou Z, Liu L, et al. Association between serum total homocysteine and arterial stiffness in adults: a community-based study. J Clin Hypertens (Greenwich). 2018;20(4):686–93. Zhang Z, Xiao S, Yang C, Ye R, Hu X, Chen X. Association of Elevated Plasma Homocysteine Level with Restenosis and Clinical Outcomes After Percutaneous Coronary Interventions: a Systemic Review and Meta-analysis. Cardiovasc Drugs Ther. 2019;33(3):353–61. Guo J, Gao Y, Ahmed M, Dong P, Gao Y, Gong Z, Liu J, Mao Y, Yue Z, Zheng Q, et al. Serum Homocysteine Level Predictive Capability for Severity of Restenosis Post Percutaneous Coronary Intervention. Front Pharmacol. 2022;13:816059. Si J, Li XW, Wang Y, Zhang YH, Wu QQ, Zhang LM, Zuo XB, Gao J, Li J. Relationship between serum homocysteine levels and long-term outcomes in patients with ST-segment elevation myocardial infarction. Chin Med J (Engl). 2019;132(9):1028–36. Yeh JK, Chen CC, Hsieh MJ, Tsai ML, Yang CH, Chen DY, Chang SH, Wang CY, Lee CH, Hsieh IC. Impact of Homocysteine Level on Long-term Cardiovascular Outcomes in Patients after Coronary Artery Stenting. J Atheroscler Thromb. 2017;24(7):696–705. Ambrosi P, Rolland P, Garçon D. [Homocysteine, a risk factor of atherosclerosis]. Arch Mal Coeur Vaiss. 1996;89(12):1667–71. Chen C, Halkos ME, Surowiec SM, Conklin BS, Lin PH, Lumsden AB. Effects of homocysteine on smooth muscle cell proliferation in both cell culture and artery perfusion culture models. J Surg Res. 2000;88(1):26–33. Chia S, Wilson R, Ludlam CA, Webb DJ, Flapan AD, Newby DE. Endothelial dysfunction in patients with recent myocardial infarction and hyperhomocysteinaemia: effects of vitamin supplementation. Clin Sci (Lond). 2005;108(1):65–72. Davis KR, Pearson H, Moat S, Bonham JR, Donnelly R. Acute hyperhomocysteinaemia affects pulse pressure but not microvascular vasodilator function. Br J Clin Pharmacol. 2001;52(3):327–32. Chua S, Wu CJ, Chang HW, Hang CL, Chen CJ, Yang CH, Yip HK. Impact of elevated plasma total homocysteine concentration on coronary atherosclerosis in Chinese patients with acute myocardial infarction undergoing primary coronary intervention. Int Heart J. 2005;46(2):181–93. B vitamins in. patients with recent transient ischaemic attack or stroke in the VITAmins TO Prevent Stroke (VITATOPS) trial: a randomised, double-blind, parallel, placebo-controlled trial. Lancet Neurol. 2010;9(9):855–65. Albert CM, Cook NR, Gaziano JM, Zaharris E, MacFadyen J, Danielson E, Buring JE, Manson JE. Effect of folic acid and B vitamins on risk of cardiovascular events and total mortality among women at high risk for cardiovascular disease: a randomized trial. JAMA. 2008;299(17):2027–36. Ebbing M, Bønaa KH, Arnesen E, Ueland PM, Nordrehaug JE, Rasmussen K, Njølstad I, Nilsen DW, Refsum H, Tverdal A, et al. Combined analyses and extended follow-up of two randomized controlled homocysteine-lowering B-vitamin trials. J Intern Med. 2010;268(4):367–82. Løland KH, Bleie O, Blix AJ, Strand E, Ueland PM, Refsum H, Ebbing M, Nordrehaug JE, Nygård O. Effect of homocysteine-lowering B vitamin treatment on angiographic progression of coronary artery disease: a Western Norway B Vitamin Intervention Trial (WENBIT) substudy. Am J Cardiol. 2010;105(11):1577–84. Cheng G, Chang FJ, Wang Y, You PH, Chen HC, Han WQ, Wang JW, Zhong NE, Min ZQ. Factors Influencing Stent Restenosis After Percutaneous Coronary Intervention in Patients with Coronary Heart Disease: A Clinical Trial Based on 1-Year Follow-Up. Med Sci Monit. 2019;25:240–7. Garcia S, Murray ST, Moritz TE, Pierpont G, Goldman S, Larsen GC, Littooy F, Ward HB, McFalls EO. Culprit coronary lesions requiring percutaneous coronary intervention after vascular surgery often arise from in-stent restenosis of bare metal stents. Ann Vasc Surg. 2010;24(5):596–601. Schaffer A, Verdoia M, Barbieri L, Cassetti E, Suryapranata H, De Luca G. Impact of Diabetes on Homocysteine Levels and Its Relationship with Coronary Artery Disease: A Single-Centre Cohort Study. Ann Nutr Metab. 2016;68(3):180–8. Yan G, Wang D, Qiao Y, Kong W, Sha X, Cheng T, Zhang H, Hou J, Tang C, Ma G. [Relationship between hyperhomocysteine and long-term outcome of coronary artery disease patients after drug-eluting stent implantation]. Zhonghua xin xue guan bing za zhi. 2015;43(11):943–7. Schnyder G, Roffi M, Flammer Y, Pin R, Hess OM. Effect of homocysteine-lowering therapy with folic acid, vitamin B12, and vitamin B6 on clinical outcome after percutaneous coronary intervention: the Swiss Heart study: a randomized controlled trial. JAMA. 2002;288(8):973–9. Ebbing M, Bleie Ø, Ueland PM, Nordrehaug JE, Nilsen DW, Vollset SE, Refsum H, Pedersen EK, Nygård O. Mortality and cardiovascular events in patients treated with homocysteine-lowering B vitamins after coronary angiography: a randomized controlled trial. JAMA. 2008;300(7):795–804. Genser D, Prachar H, Hauer R, Halbmayer WM, Mlczoch J, Elmadfa I. Relation of homocysteine, vitamin B(12), and folate to coronary in-stent restenosis. Am J Cardiol. 2002;89(5):495–9. Ma Y, Li L, Geng XB, Hong Y, Shang XM, Tan Z, Song YX, Zhao GY, Zhao BQ, Tian MR. Correlation Between Hyperhomocysteinemia and Outcomes of Patients With Acute Myocardial Infarction. Am J Ther. 2016;23(6):e1464–8. Hu F, Lu F, Huang X, Cheng X. Relationship Between Plasma Total Homocysteine Levels and Mean Corrected TIMI Frame Count in Patients with Acute Myocardial Infarction. Int J Gen Med. 2021;14:8161–72. Timizheva KB, Ahmed AAM, Ait Aissa A, Aghajanyan AV, Tskhovrebova LV, Azova MM. Association of the DNA Methyltransferase and Folate Cycle Enzymes' Gene Polymorphisms with Coronary Restenosis. Life (Basel) 2022, 12(2). Chung SL, Chiou KR, Charng MJ. 677TT polymorphism of methylenetetrahydrofolate reductase in combination with low serum vitamin B12 is associated with coronary in-stent restenosis. Catheter Cardiovasc Interv. 2006;67(3):349–55. Botto N, Andreassi MG, Rizza A, Berti S, Bevilacqua S, Federici C, Palmieri C, Glauber M, Biagini A. C677T polymorphism of the methylenetetrahydrofolate reductase gene is a risk factor of adverse events after coronary revascularization. Int J Cardiol. 2004;96(3):341–5. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4185370","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":286048273,"identity":"a8e5fb29-3d96-4bc5-a63a-f15149dfbc46","order_by":0,"name":"Kai Lan","email":"","orcid":"","institution":"Jinshan Hospital of Fudan University","correspondingAuthor":false,"prefix":"","firstName":"Kai","middleName":"","lastName":"Lan","suffix":""},{"id":286048274,"identity":"4fed00d7-6389-4e39-8ccb-2800c7377427","order_by":1,"name":"Hui Gong","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4UlEQVRIie3PsQrCMBCA4SuBxiGaNUV8h4BQBIvP0iJ0EhF8gYJQF937GLq5GT106gMoODi5CQUXBQWr6OLQOArmX265j0sATKYfrEKeQwEnRKlMei0tsd/EGcbBIumFbT2BF5FpWkeWLa1ISyhzxWW268LGl+hJRYDialL8MOY64/TQtxLfx47cVYCF4UZHRDnGYCB8lZMDAcFcLXFuOYlFEGFDohV9Q6qPKyOGgPAdsfvNWk4SGsNiJMO2rfsL5zjdHnMyR37KzlevxSmuCwlASX7cLV5/RPf6HZPJZPrv7orYTIlKuiBCAAAAAElFTkSuQmCC","orcid":"","institution":"Jinshan Hospital of Fudan University","correspondingAuthor":true,"prefix":"","firstName":"Hui","middleName":"","lastName":"Gong","suffix":""}],"badges":[],"createdAt":"2024-03-29 03:29:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4185370/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4185370/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54108044,"identity":"8351f59e-7792-40b2-b2d8-1fa6f18f5e47","added_by":"auto","created_at":"2024-04-04 17:33:29","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":78568,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4185370/v1/4091a2ee0b56ee689b59c624.png"},{"id":54108053,"identity":"cbd16030-fbe3-4af7-9b1d-67b1b32bff9b","added_by":"auto","created_at":"2024-04-04 17:33:29","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":33932,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4185370/v1/5ec8d8568ffffdf11c3934e6.png"},{"id":56001969,"identity":"7fb56780-8f30-4cdc-bd15-3a78f7e60789","added_by":"auto","created_at":"2024-05-07 11:59:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":602053,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4185370/v1/988ad4e4-26e4-4c7e-888a-84a951cb410f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eEffect of hyperhomocysteine in patients after PCI for non-ST-segment elevation myocardial infarction, a retrospective study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCardiovascular disease is a prominent contributor to mortality worldwide and is responsible for over 30% of the global annual fatality rate.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]The incidence of total cardiovascular disease cases almost doubled from 271\u0026nbsp;million in 1990 to 523\u0026nbsp;million by 2019, and the mortality of cardiovascular diseases significantly increased from 12.1\u0026nbsp;million in 1990, reaching 18.6\u0026nbsp;million in 2019.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] Coronary artery disease is becoming increasingly common worldwide and is the leading cause of death from cardiovascular diseases. In China, Acute Coronary Syndrome (ACS) accounts for 50% of cardiovascular disease mortality and is the most common form of coronary heart disease.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] Several studies have shown that myocardial revascularization by percutaneous coronary intervention (PCI )more effectively relieves angina, reduces the use of anti-anginal drugs, and improves exercise capacity and quality of life compared with a strategy of medical therapy alone during short- and long-term follow-up.[\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] Homocysteine (Hcy) is a non-essential amino acid that can cause endothelial damage, which is the starting point of atherosclerosis.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] Elevated serum Hcy increases oxidative stress and stimulates the proliferation of vascular smooth muscle cells, thereby increasing the risk of atherosclerosis.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] Homocysteine, as an independent risk factor for coronary artery disease, not only contributes to the development of ACS through a variety of means, but also affects the prognosis of patients undergoing percutaneous coronary intervention for ACS. A recent study showed serum Hcy concentrations was positively correlated with the prevalence of vascular sclerosis.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]Some study were concentrating on the relationship between homocysteine and stent restenosis[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, studies have assessed the predictive value of serum HCY in patients with ST-segment elevation myocardial infarction (STEMI).[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] There are few studies on the effect of high Hcy level on the prognosis of patients undergoing percutaneous coronary intervention in the emergency setting of non-ST-segment elevation myocardial infarction (NSTEMI), especially in Asian populations. Therefore, in this study, patients undergoing emergency PCI for NSTEMI were divided into two groups according to homocysteine, and the occurrence of adverse events were analyzed to determine the effect of Hcy level on the prognosis of the patients.\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003ePatients\u003c/p\u003e \u003cp\u003eIn this retrospective study, collected from Jinshan Hospital Affiliated to Fudan University from January 2018 to December 2021 diagnosed as NSTEMI and successfully performed an emergency PCI 280 patients were treated. The inclusion criteria included if the patient fulfills 2 of the following 3 standards: 1)Chest pain lasting at least half an hour or more, consistent with chest pain from a heart attack 2༉elevated concentration of a circulating marker of myocardial necrosis cardiac troponin I (cTnI ) or creatine kinase myocardial band (CK-MB), elevated high-sensitivity troponin levels present within 3 h, serum markers of myocardial injury exceed the 99th percentile of the upper limit of normal 3༉had a dynamic evolutionary process electrocardiography are associated with ST segment depressions, T-wave inversions. The exclusion criteria were as : 1) severe hepatic or renal insufficiency; 2) suffering from severe metabolic diseases (gout, hypothyroidism); 3) severed infections; 4) advanced malignant tumors;5) hematologic diseases; 6) active ulcers and bleeding; 7) history of major surgery and trauma and other anticoagulant contraindications, contraindications to anticoagulation such as history of surgical trauma and allergy to aspirin 8) duplex antiplatelet less than 12 months after stenting 9) had taken any drugs in the past three months that affect the horizontal position of plasma HCY\u003c/p\u003e \u003cp\u003eData Collection\u003c/p\u003e \u003cp\u003eClinical data of the enrolled patients were recorded, including gender, age, blood pressure, body mass index(BMI), smoking, alcohol consumption, past medical history (hypertension, diabetes mellitus, atrial fibrillation, hyperlipidemia, chronic kidney disease), dyslipidemia, relevant laboratory test results, coronary artery lesions and interventions (location of lesions, number of lesions, number of stents), all-cause mortality and major adverse cardiovascular events (MACEs) after PCI, including cardiac death, nonfatal myocardial infarction and angina and unplanned revascularization were recorded. The next day, fasting blood was drawn from the elbow and sent to the laboratory for hematological analysis. Heart rates and blood pressure were measured when were hospitalized by nurse.\u003c/p\u003e \u003cp\u003eThe following definitions were used: hypertension,blood pressure\u0026thinsp;\u0026ge;\u0026thinsp;140/90mmHg or antihypertensive treatment; hypercholesterolemia, total cholesterol\u0026thinsp;\u0026gt;\u0026thinsp;200mg/dL (5.2mmol/L); diabetes mellitus, fasting plasma glucose\u0026thinsp;\u0026gt;\u0026thinsp;125mg/dL (7.0mmol/L) or glucose lowering treatment. Atrial fibrillation, diagnosed by ECG or previously diagnosed and on medication. Chronic kidney disease with abnormal function for \u0026ge;\u0026thinsp;3 months or previously diagnosed. Cigarette smoking was defined as having smoked at least one cigarette per day or 20 packs or more in the past year. Alcohol consumption was defined as drinking alcohol at least twice per week in the past year.\u003c/p\u003e \u003cp\u003ePatients were discharged from the hospital as the starting point for follow-up. All patients were followed by telephone, the inpatient and outpatient medical records systems. Postoperative all-cause mortality and major adverse cardiovascular events were recorded.\u003c/p\u003e \u003cp\u003e \u003cem\u003eStatistical analysis\u003c/em\u003e:\u003c/p\u003e \u003cp\u003eThe clinical data of the study participants were summarized and analyzed. Continuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) and t-test was used for comparison between groups. Categorical variables were expressed as percentages and non-parametric comparisons between groups by using chi-square test or Fisher exact test. COX one-way analysis was performed based on the included study variables, and P less than 0.1 was included in the multifactorial COX proportional risk models. MACE-free survival curve was depicted by the Kaplan\u0026ndash;Meier method and differences between the two groups were assessed by the log-rank test. P value less than 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 280 patients met the eligibility criteria to be included as study participants in the registry. The final sample size was 269 due to 11 patients who were lost to interview and could not be analyzed (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Consecutive enrollment of patients (mean age 64\u0026thinsp;\u0026plusmn;\u0026thinsp;12 years, range 32\u0026ndash;91 years; 82.9% male) was undertaken for analysis (Table.1). The patients were categorized into two groups based on the baseline plasma total HCY level. Cut-off value of 15 \u0026micro;mol/L: Group 1 (142 patients, HCY\u0026thinsp;\u0026lt;\u0026thinsp;15 \u0026micro;mol/L) and Group 2 (127 patients, \u0026ge;\u0026thinsp;15 \u0026micro;mol/L) were compared based on their baseline characteristics, as presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e. There was no statistical difference in BMI, heart rates, systolic blood pressure and diastolic blood pressure between the two groups. Traditional coronary risk factors, including age, hypertension, diabetes mellitus, and hypercholesterolemia were compared between groups. For personal and history, there is no statistical difference in smoking, alcoholic consumption, hypertension, diabetes, dyslipidemia, and atrial fibrillation. About laboratory test, except creatinine have statistical difference.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ebaseline\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u0026lt;15.0 \u0026micro;mol/L\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;142)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;15.0 \u0026micro;mol/L\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;127)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e113(79.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e110(86.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.126\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62(43.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e68(53.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.105\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcoholic consumption, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31(21.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e28(22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.966\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50(35.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e38(29.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.356\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50(35.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e43(33.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.816\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyslipidemia, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19(13.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e18(14.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.850\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAtrial fibrillation, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11(7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5(3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.187\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic kidney disease, n(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e12(9.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (y, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62.4\u0026thinsp;\u0026plusmn;\u0026thinsp;12.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e67.0\u0026thinsp;\u0026plusmn;\u0026thinsp;12.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e24.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78\u0026thinsp;\u0026plusmn;\u0026thinsp;14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e79\u0026thinsp;\u0026plusmn;\u0026thinsp;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.573\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystolic blood pressure(mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e132\u0026thinsp;\u0026plusmn;\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e131\u0026thinsp;\u0026plusmn;\u0026thinsp;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.972\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiastolic pressure\u003c/p\u003e \u003cp\u003e(mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79\u0026thinsp;\u0026plusmn;\u0026thinsp;13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e78\u0026thinsp;\u0026plusmn;\u0026thinsp;14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.257\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobin(g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e133\u0026thinsp;\u0026plusmn;\u0026thinsp;17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e133\u0026thinsp;\u0026plusmn;\u0026thinsp;16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.904\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlatelet(10\u003csup\u003e˄9\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e202\u0026thinsp;\u0026plusmn;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e196\u0026thinsp;\u0026plusmn;\u0026thinsp;53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.371\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreatinine (umol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72.8\u0026thinsp;\u0026plusmn;\u0026thinsp;16.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e101.1\u0026thinsp;\u0026plusmn;\u0026thinsp;59.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFasting glucose(umol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.55\u0026thinsp;\u0026plusmn;\u0026thinsp;3.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e7.43\u0026thinsp;\u0026plusmn;\u0026thinsp;4.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.803\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlycated hemoglobin(umol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.89\u0026thinsp;\u0026plusmn;\u0026thinsp;1.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e6.60\u0026thinsp;\u0026plusmn;\u0026thinsp;1.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.904\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTriglyceride(umol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.94\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1.76\u0026thinsp;\u0026plusmn;\u0026thinsp;1.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.212\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCholesterol(umol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.77\u0026thinsp;\u0026plusmn;\u0026thinsp;1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e4.51\u0026thinsp;\u0026plusmn;\u0026thinsp;1.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.084\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLDL cholesterol(mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDL cholesterol(mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.98\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.319\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeak Myoglobin(ng/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e265\u0026thinsp;\u0026plusmn;\u0026thinsp;197\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e329\u0026thinsp;\u0026plusmn;\u0026thinsp;387\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.600\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeak cTnI (ng/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.26\u0026thinsp;\u0026plusmn;\u0026thinsp;9.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e10.87\u0026thinsp;\u0026plusmn;\u0026thinsp;11.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.639\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeak CK-MB (ng/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47.79\u0026thinsp;\u0026plusmn;\u0026thinsp;53.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e42.89\u0026thinsp;\u0026plusmn;\u0026thinsp;32.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.382\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft main,n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e3(2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.262\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLAD,n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56(39.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e38(29.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.102\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLCX, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42(29.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e45(35.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.305\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRCA, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37(26.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e35(27.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.781\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGraft, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e6(4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.843\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehistory of PCI, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23(16.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e27(21.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.287\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLesion length, (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2.70\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.645\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStent size, (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.86\u0026thinsp;\u0026plusmn;\u0026thinsp;5.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e22.16\u0026thinsp;\u0026plusmn;\u0026thinsp;5.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.683\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of stents per lesion(mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eLAD: left anterior descending LCX: left circumflex RCA: right coronary artery\u003c/p\u003e \u003cp\u003eNo correlation was observed between in hemoglobin, platelets, fasting plasma glucose, glycated hemoglobin, triglycerides, total cholesterol, triglycerides, LDL-c,HDL-c .In addition, peak myoglobin, peak cTnI and peak CK-MB were not significantly different between the two groups and were all above normal standards. As for coronary artery lesions and interventions there was no significant difference in lesion location, history of PCI between the two groups. Furthermore, there was no significant difference in the sizes and lengths of the implanted coronary artery stents between the two groups. The number of stents per lesion has no differences. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section3\"\u003e \u003cdiv class=\"Heading\"\u003e\u003cp\u003e\u003cb\u003eLong-Term Clinical Outcomes:\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e \u003cp\u003eA total of 269 patients, who survived and discharged from hospital after PCI, were followed up for a mean of 36\u0026thinsp;\u0026plusmn;\u0026thinsp;14 months. The patients in group Ⅱ had a significantly higher mortality rate than those in group Ⅰ (8.7% vs. 2.1%, p\u0026thinsp;=\u0026thinsp;0.016) and all of them were from cardiac death. In addition, the group Ⅱ patients had a higher MACE rate than group Ⅰ patients (33.9% vs. 17.6%, p\u0026thinsp;=\u0026thinsp;0.002) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e). However, people with non-fatal MI, new lesion stenting, non-fatal stroke has no significant difference between two groups. In Kaplan\u0026ndash;Meier analysis, there was a significant difference in the MACE-free survival rate between the two groups (log-rank test; p\u0026thinsp;=\u0026thinsp;0.022) (Figure.2).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical events during long-term follow-up\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;15.0 \u0026micro;mol/L\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;142)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;15.0 \u0026micro;mol/L\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;127)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiac death, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(8.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-fatal MI, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNew lesion stenting, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13(9.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(8.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.887\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-fatal stroke, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.289\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMACE, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25(17.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43(33.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAccording to the univariate Cox proportional hazards analysis, the MACE rates were significantly associated with age and plasma HCY levels\u0026thinsp;\u0026ge;\u0026thinsp;15 \u0026micro;mol/L. After adjusting for age, gender, hypertension, diabetes mellitus, hyperlipidemia, serum creatinine, HCY levels\u0026thinsp;\u0026ge;\u0026thinsp;15 \u0026micro;mol/L, creatinine, history of PCI, number of stents per lesion, smoking, alcoholic history, and BMI, only age remained as a statistically significant predictor for long-term cardiovascular outcomes, with a HR of 1.97 (95% CI: 1.14\u0026ndash;3.39, p\u0026thinsp;=\u0026thinsp;0.014). (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCox Proportional\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCox\u003c/p\u003e \u003cp\u003eProportional\u003c/p\u003e \u003cp\u003eHazards Regression\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eUnivariate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eMultivariate\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePredictors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eHR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHomocysteine (\u0026ge;\u0026thinsp;15.0 \u0026micro;mol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.968\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.10-12.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.417\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.57\u0026ndash;10.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.230\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.553\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.17\u0026ndash;1.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.316\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.894\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.22\u0026ndash;3.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.875\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.569\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.15\u0026ndash;2.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.386\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.353\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.07\u0026ndash;1.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.182\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.261\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.39\u0026ndash;4.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.695\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.994\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.28\u0026ndash;3.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.992\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyperlipidemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.26\u0026ndash;5.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.827\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.40\u0026ndash;11.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.370\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreatinine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.99\u0026ndash;1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.350\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.99\u0026ndash;1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.650\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehistory of PCI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.27\u0026ndash;3.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.996\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.913\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.24\u0026ndash;3.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.893\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of stents per lesion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.790\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.87\u0026ndash;3.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.998\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.24\u0026ndash;3.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.118\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge(every 10 years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.281\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.36\u0026ndash;3.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.973\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.14\u0026ndash;3.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.467\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.14\u0026ndash;1.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.270\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.06\u0026ndash;1.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.086\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcoholic history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.487\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.46\u0026ndash;4.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.503\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.909\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.60-13.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.181\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.942\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.79\u0026ndash;1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.487\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.076\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.87\u0026ndash;1.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.490\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e "},{"header":"Discussion","content":"\u003cp\u003eIn up to a mean of 36\u0026thinsp;\u0026plusmn;\u0026thinsp;14 months of follow-up, three main results were found in the current study. First, the mortality rate and MACE rate were significantly lower in the low homocysteine group than in the high homocysteine group. Second, the univariate Cox proportional hazards analysis, the MACE rates were significantly associated with age and plasma HCY levels\u0026thinsp;\u0026ge;\u0026thinsp;15 \u0026micro;mol/L. However, while after adjusting for age, gender, hypertension, diabetes mellitus, hyperlipidemia, serum creatinine, HCY levels\u0026thinsp;\u0026ge;\u0026thinsp;15 \u0026micro;mol/L, creatinine, history of PCI, number of stents per lesion, smoking, alcoholic history, and BMI, only age remained as a statistically significant predictor for long-term cardiovascular outcomes, with a HR of 1.97 (95% CI: 1.14\u0026ndash;3.39, p\u0026thinsp;=\u0026thinsp;0.014).Finally, in Kaplan\u0026ndash;Meier analysis, there was a significant difference in the MACE-free survival rate between the two groups (log-rank test; p\u0026thinsp;=\u0026thinsp;0.037).\u003c/p\u003e \u003cp\u003eMany studies have now shown that hyperhomocysteinemia is an independent risk factor for coronary and cerebrovascular disease. In recent years some studies have also tried to explore the relationship between homocysteine and prognosis in coronary arteries. A study from the institutional registry of Cardiovascular Atherosclerosis and Percutaneous TrAnsluminal Interventions (CAPTAIN) enrolled 1,307 patients with documented CAD undergone PCI with bare metal stents from July 2003 to December 2014. All of the patients were divided into two groups according to fasting plasma HCY levels: group Ⅰ (883 patients, \u0026lt;12 \u0026micro;mol/L) and group II (424 patients, \u0026ge;\u0026thinsp;12 \u0026micro;mol/L). After a mean follow-up period of 58\u0026thinsp;\u0026plusmn;\u0026thinsp;41 months, the group II patients had a higher MACE rate (33.3% vs. 25.6%, p\u0026thinsp;=\u0026thinsp;0.005) .Elevated HCY levels (\u0026ge;\u0026thinsp;12 \u0026micro;mol/L) were independently associated with an increased risk of long-term cardiovascular events in patients after coronary bare metal stent implantation.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]In our study, mortality and MACE were higher in the group with high homocysteine levels compared to the group with normal homocysteine levels. However, their study focused on metal stents, while all of our patients received second-generation drug-eluting stents, which may also have contributed to our different results. Hcy is a sulfur-containing amino acid produced by the metabolism of methionine. It is now thought to contribute to atherosclerotic plaque formation and adverse cardiovascular events through a variety of mechanisms and adverse cardiovascular events.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] However, the pathophysiological mechanisms were not fully understood. Basic studies have shown that high homocysteine significantly stimulates the proliferation of cultured human and porcine smooth muscle cells, while inhibiting the growth of cultured endothelial cells. Vascular injury stimulates smooth muscle proliferation, which is further enhanced by homocysteine in a dose-dependent manner.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] Hcy is a prothrombotic disorder that may lead to oxidative endothelial damage and impair endogenous fibrinolysis.[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]In addition, Hcy also has a diastolic response to small vessels (especially in non-nitric oxide-mediated pathways), which predisposes to rupture of vulnerable plaques, leading to the progression of atherosclerosis and ultimately to atherosclerotic events. This can lead to the rupture of vulnerable plaques, leading to the progression of atherosclerosis and ultimately to cardiovascular events.[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] The extent of the association between acute myocardial infarction (AMI) and hyperhomocysteine remains unknown. In a prospective study of a Chinese population, researchers measured plasma Hcy levels in 178 patients with ST-segment elevation AMI treated with primary PCI, and ultimately found that elevated homocysteine concentrations were a significant risk factor for advanced diffuse coronary atherosclerosis in Chinese patients with acute myocardial infarction treated with primary PCI.[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eHowever, in many trials of Hcy-lowering treatments, such as vitamin B12 and folic acid supplements, there were no beneficial effects on cardiovascular disease prevention.[\u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] Therefore, vitamin B12 and folic acid supplements were not included in our study protocol.It is generally believed that infarct-related in-stent restenosis is one of the most important prognostic factors for patients with ACS after PCI, and it is also one of the major difficulties in the treatment of ACS. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]Most studies have evaluated the effect of elevated Hcy levels on restenosis after PCI, and few studies have evaluated mortality in patients with CAD after PCI by baseline plasma Hcy levels[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Few studies have assessed mortality in patients with myocardial infarction after PCI by baseline plasma Hcy levels, especially in non-ST-segment elevation myocardial infarction.[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] However, the effect of homocysteine on restenosis is controversial, the present study provides evidence that elevated plasma Hcy levels have a negative impact on long-term survival in patients with PCI and that patients with elevated Hcy levels (\u0026ge;\u0026thinsp;15 mmol/L) had significantly higher mortality than those with low levels (\u0026lt;\u0026thinsp;15 mmol/L), after adjusting for other factors that may affect the prognosis of PCI. However regarding hyperhomocysteine and stent restenosis, a meta-analysis that included 4340 participants showed that although there was no clear association between higher Hcy levels and restenosis after stenting, higher Hcy levels appeared to increase the risk of restenosis after coronary angioplasty and increased the risk of all-cause mortality, MACE, and cardiac death after PCI.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] J. Guo\u0026rsquo;s study about the correlation between Hcy and ISR severity found a positive correlation between homocysteine and the severity of restenosis after PCI. In addition, ROC curve analysis showed that serum Hcy level could be used as a predictive biomarker of ISR severity after PCI.[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] A number of other studies have been conducted in support of a better prognostic correlation between interventions to lower blood Hcy levels (folic acid, vitamin B6, and vitamin B12) after PCI in patients with hyperhomocysteinemia and after PCI. For example, Schnyder et al.[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] conducted a study enrolled 553 patients undergoing angioplasty and found that the primary adverse cardiac event composite endpoint was significantly lower in the intervention group than in the non-intervention group. However, some studies of the effect of elevated Hcy on PCI outcomes have reached negative conclusions; A study by Ebbing et al.[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] included 3096 patients after PCI and found no prognostic impact of Hcy after a median follow-up of 38 months. In addition, another small study by Genser et al.[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] followed 292 patients who successfully underwent PCI. At six-month follow-up, stent restenosis was not associated with Hcy levels.At six months of follow-up, stent restenosis was not associated with Hcy levels.\u003c/p\u003e \u003cp\u003eFor increased cardiac mortality in patients with hyperhomocysteinemia, a study comparing the relationship between hyperhomocysteinaemia and short-term prognosis in patients with acute myocardial infarction. Eighty-five patients were divided into two groups based on plasma Hcy levels. Gender, hypertension, diabetes mellitus, hyperlipidaemia, time from onset of symptoms to percutaneous coronary intervention, homocysteine, creatine kinase isoforms, and the incidence of 30-day adverse events were compared between the two groups. The overall incidence of adverse cardiovascular events was found to be significantly higher in the plasma Hcy group than in the comparison group, but the incidence of postprocedural angina and reinfarction was similar in all groups. They therefore concluded that elevated total plasma Hcy levels in patients with acute myocardial infarction undergoing percutaneous coronary intervention may be associated with short-term prognosis. Although this is similar to the results of our study, the short duration of this study and had a small sample size, which may have been affected by patient selection bias.[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] Similar trials have demonstrated that elevated Hcy levels in patients with AMI are independent of other risk factors and are associated with a higher incidence of coronary events.[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] The present study is in agreement with the results of most studies that high Hcy can exacerbate coronary artery disease and that serum Hcy levels had an important prognostic value for the long-term prognosis of patients with NSTEMI.\u003c/p\u003e \u003cp\u003eThis study had several limitations. First, homocysteine metabolism is also influenced by diet, and we were unable to adjust for individual differences. Second, the methylenetetrahydrofolate reductase (MTHFR) enzyme, folate, vitamin B6, and vitamin B12 are required for the metabolism of homocysteine to methionine or cysteine. However, the MTHFR C677T gene has a polymorphism associated with hyperhomocysteinaemia.[\u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] In our study protocol, we did not routinely measure serum folate, vitamin B12 and gene polymorphisms, which resulted in no way to understand the interaction between them in terms of risk of cardiovascular events. Third, our sample size was small, which may have led to trial bias. Therefore, we need to further increase the sample size for inclusion in the future, as well as extend the follow-up time. Finally, we did not consider the effect of drugs on homocysteine.\u003c/p\u003e \u003cp\u003eIn conclusion, serum Hcy level is an independent risk factor for adverse cardiovascular events after PCI in patients with NSTEMI.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e：\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe would like to thank the Information Department of Jinshan Hospital, Fudan University, for data retrieval and other arrangements.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions：\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGH was responsible for the idea design, statistical technical support, and content of the article. LK wrote the article. LK was\u0026nbsp;responsible for part of the data analysis and language correction. LK and GH were responsible for clinical data collection, literature search, and other contributions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e：\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e：\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from Jinshan Hospital Affiliated to Fudan University, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the corresponding author upon reasonable request and with permission of Jinshan Hospital Affiliated to Fudan University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e：\u003c/p\u003e\n\u003cp\u003eThe studies involving human participants were reviewed and approved by Ethics Committee Approval letter of Jinshan Hospital, Fudan University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003e1. Department of Cardiology, Jinshan Hospital Affiliated to Fudan University,Shanghai201500，China. \u0026nbsp;Email: [email protected]\u003c/p\u003e\n\u003cp\u003e2. Department of Cardiology, Jinshan Hospital Affiliated to Fudan University Shanghai201500，China. \u0026nbsp;Email: [email protected] \u0026nbsp; ORCID id:0000-0002-7833-433X\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePagidipati NJ, Gaziano TA. Estimating deaths from cardiovascular disease: a review of global methodologies of mortality measurement. Circulation. 2013;127(6):749\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, Barengo NC, Beaton AZ, Benjamin EJ, Benziger CP, et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990\u0026ndash;2019: Update From the GBD 2019 Study. J Am Coll Cardiol. 2020;76(25):2982\u0026ndash;3021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu S, Li Y, Zeng X, Wang H, Yin P, Wang L, Liu Y, Liu J, Qi J, Ran S, et al. Burden of Cardiovascular Diseases in China, 1990\u0026ndash;2016: Findings From the 2016 Global Burden of Disease Study. JAMA Cardiol. 2019;4(4):342\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNeumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, et al. : 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019;40(2):87\u0026ndash;165.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStergiopoulos K, Brown DL. Initial coronary stent implantation with medical therapy vs medical therapy alone for stable coronary artery disease: meta-analysis of randomized controlled trials. Arch Intern Med. 2012;172(4):312\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKatritsis DG, Ioannidis JP. Percutaneous coronary intervention versus conservative therapy in nonacute coronary artery disease: a meta-analysis. Circulation. 2005;111(22):2906\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChristen WG, Cook NR, Van Denburgh M, Zaharris E, Albert CM, Manson JE. Effect of Combined Treatment With Folic Acid, Vitamin B(6), and Vitamin B(12) on Plasma Biomarkers of Inflammation and Endothelial Dysfunction in Women. J Am Heart Assoc 2018, 7(11).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKarolczak K, Kubalczyk P, Glowacki R, Pietruszynski R, Watala C. Aldosterone modulates blood homocysteine and cholesterol in coronary artery disease patients - a possible impact on atherothrombosis? Physiol Res. 2018;67(2):197\u0026ndash;207.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen L, Wang B, Wang J, Ban Q, Wu H, Song Y, Zhang J, Cao J, Zhou Z, Liu L, et al. Association between serum total homocysteine and arterial stiffness in adults: a community-based study. J Clin Hypertens (Greenwich). 2018;20(4):686\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang Z, Xiao S, Yang C, Ye R, Hu X, Chen X. Association of Elevated Plasma Homocysteine Level with Restenosis and Clinical Outcomes After Percutaneous Coronary Interventions: a Systemic Review and Meta-analysis. Cardiovasc Drugs Ther. 2019;33(3):353\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuo J, Gao Y, Ahmed M, Dong P, Gao Y, Gong Z, Liu J, Mao Y, Yue Z, Zheng Q, et al. Serum Homocysteine Level Predictive Capability for Severity of Restenosis Post Percutaneous Coronary Intervention. Front Pharmacol. 2022;13:816059.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSi J, Li XW, Wang Y, Zhang YH, Wu QQ, Zhang LM, Zuo XB, Gao J, Li J. Relationship between serum homocysteine levels and long-term outcomes in patients with ST-segment elevation myocardial infarction. Chin Med J (Engl). 2019;132(9):1028\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYeh JK, Chen CC, Hsieh MJ, Tsai ML, Yang CH, Chen DY, Chang SH, Wang CY, Lee CH, Hsieh IC. Impact of Homocysteine Level on Long-term Cardiovascular Outcomes in Patients after Coronary Artery Stenting. J Atheroscler Thromb. 2017;24(7):696\u0026ndash;705.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmbrosi P, Rolland P, Gar\u0026ccedil;on D. [Homocysteine, a risk factor of atherosclerosis]. Arch Mal Coeur Vaiss. 1996;89(12):1667\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen C, Halkos ME, Surowiec SM, Conklin BS, Lin PH, Lumsden AB. Effects of homocysteine on smooth muscle cell proliferation in both cell culture and artery perfusion culture models. J Surg Res. 2000;88(1):26\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChia S, Wilson R, Ludlam CA, Webb DJ, Flapan AD, Newby DE. Endothelial dysfunction in patients with recent myocardial infarction and hyperhomocysteinaemia: effects of vitamin supplementation. Clin Sci (Lond). 2005;108(1):65\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavis KR, Pearson H, Moat S, Bonham JR, Donnelly R. Acute hyperhomocysteinaemia affects pulse pressure but not microvascular vasodilator function. Br J Clin Pharmacol. 2001;52(3):327\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChua S, Wu CJ, Chang HW, Hang CL, Chen CJ, Yang CH, Yip HK. Impact of elevated plasma total homocysteine concentration on coronary atherosclerosis in Chinese patients with acute myocardial infarction undergoing primary coronary intervention. Int Heart J. 2005;46(2):181\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eB vitamins in. patients with recent transient ischaemic attack or stroke in the VITAmins TO Prevent Stroke (VITATOPS) trial: a randomised, double-blind, parallel, placebo-controlled trial. Lancet Neurol. 2010;9(9):855\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlbert CM, Cook NR, Gaziano JM, Zaharris E, MacFadyen J, Danielson E, Buring JE, Manson JE. Effect of folic acid and B vitamins on risk of cardiovascular events and total mortality among women at high risk for cardiovascular disease: a randomized trial. JAMA. 2008;299(17):2027\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEbbing M, B\u0026oslash;naa KH, Arnesen E, Ueland PM, Nordrehaug JE, Rasmussen K, Nj\u0026oslash;lstad I, Nilsen DW, Refsum H, Tverdal A, et al. Combined analyses and extended follow-up of two randomized controlled homocysteine-lowering B-vitamin trials. J Intern Med. 2010;268(4):367\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eL\u0026oslash;land KH, Bleie O, Blix AJ, Strand E, Ueland PM, Refsum H, Ebbing M, Nordrehaug JE, Nyg\u0026aring;rd O. Effect of homocysteine-lowering B vitamin treatment on angiographic progression of coronary artery disease: a Western Norway B Vitamin Intervention Trial (WENBIT) substudy. Am J Cardiol. 2010;105(11):1577\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheng G, Chang FJ, Wang Y, You PH, Chen HC, Han WQ, Wang JW, Zhong NE, Min ZQ. Factors Influencing Stent Restenosis After Percutaneous Coronary Intervention in Patients with Coronary Heart Disease: A Clinical Trial Based on 1-Year Follow-Up. Med Sci Monit. 2019;25:240\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGarcia S, Murray ST, Moritz TE, Pierpont G, Goldman S, Larsen GC, Littooy F, Ward HB, McFalls EO. Culprit coronary lesions requiring percutaneous coronary intervention after vascular surgery often arise from in-stent restenosis of bare metal stents. Ann Vasc Surg. 2010;24(5):596\u0026ndash;601.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchaffer A, Verdoia M, Barbieri L, Cassetti E, Suryapranata H, De Luca G. Impact of Diabetes on Homocysteine Levels and Its Relationship with Coronary Artery Disease: A Single-Centre Cohort Study. Ann Nutr Metab. 2016;68(3):180\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYan G, Wang D, Qiao Y, Kong W, Sha X, Cheng T, Zhang H, Hou J, Tang C, Ma G. [Relationship between hyperhomocysteine and long-term outcome of coronary artery disease patients after drug-eluting stent implantation]. Zhonghua xin xue guan bing za zhi. 2015;43(11):943\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchnyder G, Roffi M, Flammer Y, Pin R, Hess OM. Effect of homocysteine-lowering therapy with folic acid, vitamin B12, and vitamin B6 on clinical outcome after percutaneous coronary intervention: the Swiss Heart study: a randomized controlled trial. JAMA. 2002;288(8):973\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEbbing M, Bleie \u0026Oslash;, Ueland PM, Nordrehaug JE, Nilsen DW, Vollset SE, Refsum H, Pedersen EK, Nyg\u0026aring;rd O. Mortality and cardiovascular events in patients treated with homocysteine-lowering B vitamins after coronary angiography: a randomized controlled trial. JAMA. 2008;300(7):795\u0026ndash;804.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGenser D, Prachar H, Hauer R, Halbmayer WM, Mlczoch J, Elmadfa I. Relation of homocysteine, vitamin B(12), and folate to coronary in-stent restenosis. Am J Cardiol. 2002;89(5):495\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMa Y, Li L, Geng XB, Hong Y, Shang XM, Tan Z, Song YX, Zhao GY, Zhao BQ, Tian MR. Correlation Between Hyperhomocysteinemia and Outcomes of Patients With Acute Myocardial Infarction. Am J Ther. 2016;23(6):e1464\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHu F, Lu F, Huang X, Cheng X. Relationship Between Plasma Total Homocysteine Levels and Mean Corrected TIMI Frame Count in Patients with Acute Myocardial Infarction. Int J Gen Med. 2021;14:8161\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTimizheva KB, Ahmed AAM, Ait Aissa A, Aghajanyan AV, Tskhovrebova LV, Azova MM. Association of the DNA Methyltransferase and Folate Cycle Enzymes' Gene Polymorphisms with Coronary Restenosis. Life (Basel) 2022, 12(2).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChung SL, Chiou KR, Charng MJ. 677TT polymorphism of methylenetetrahydrofolate reductase in combination with low serum vitamin B12 is associated with coronary in-stent restenosis. Catheter Cardiovasc Interv. 2006;67(3):349\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBotto N, Andreassi MG, Rizza A, Berti S, Bevilacqua S, Federici C, Palmieri C, Glauber M, Biagini A. C677T polymorphism of the methylenetetrahydrofolate reductase gene is a risk factor of adverse events after coronary revascularization. Int J Cardiol. 2004;96(3):341\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"non-ST-segment elevation myocardial infarction, percutaneous coronary intervention, homocysteine","lastPublishedDoi":"10.21203/rs.3.rs-4185370/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4185370/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe prognostic value of homocysteine (HCY) in patients with coronary artery disease (CAD) remains controversial. The aim of this study was to investigate whether an elevated HCY level on admission can predict long-term outcomes in patients with Non-ST-Segment elevation myocardial infarction (NSTEMI) after percutaneous coronary intervention (PCI) with coronary artery stenting.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eFrom Jinshan Hospital Affiliated to Fudan University from January 2018 to December 2021, 275 patients who were diagnosed with NSTEMI and successfully underwent emergency PCI were conducted. All these patients were divided into two groups according to fasting plasma HCY levels the day after the theterization: group Ⅰ (142 patients, \u0026lt;15 \u0026micro;mol/L) and group II (127 patients, \u0026ge;\u0026thinsp;15 \u0026micro;mol/L).Primary and secondary outcome measures: The primary endpoint was the occurrence of major adverse cardiac events (MACE), including cardiac death, non-fatal myocardial infarction, stroke, and new lesion stenting.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAfter a mean follow-up of 36\u0026thinsp;\u0026plusmn;\u0026thinsp;14 months, patients in group II had a higher rate of MACE (33.9% vs. 17.6%, p\u0026thinsp;=\u0026thinsp;0.002). The main difference between the two groups was cardiac death (8.7% vs. 2.1%, p\u0026thinsp;=\u0026thinsp;0.016). The risk of long-term MACE remained significantly higher in patients with elevated HCY levels (\u0026ge;\u0026thinsp;15 \u0026micro;mol/L) with a hazard ratio of 1.29 (95% CI, 1.1-12.23, p\u0026thinsp;=\u0026thinsp;0.034). Elevated HCY levels (\u0026ge;\u0026thinsp;15 \u0026micro;mol/L) were independently associated with an increased risk of long-term cardiovascular events in patients after PCI.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThus, hyperhomocysteinemia may remain a useful prognostic marker for risk assessment in the clinical management of CAD patients.\u003c/p\u003e","manuscriptTitle":"Effect of hyperhomocysteine in patients after PCI for non-ST-segment elevation myocardial infarction, a retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-04 17:33:24","doi":"10.21203/rs.3.rs-4185370/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"eebb21b0-7255-4002-9fb1-c5da5bf84b5e","owner":[],"postedDate":"April 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-05-07T11:03:48+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-04 17:33:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4185370","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4185370","identity":"rs-4185370","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}