Citation: | AN Dongmei, LIU Jie, CAO Li. Evaluation value of serum homocysteine combined with coronary calcium score for short-term prognosis in patients with acute coronary syndrome[J]. Journal of Clinical Medicine in Practice, 2022, 26(10): 62-67. DOI: 10.7619/jcmp.20214391 |
To explore the evaluation value of detection of serum homocysteine (Hcy) combined with coronary calcium score (CCS) for short-term prognosis in patients with acute coronary syndrome (ACS).
A total of 180 hospitalized patients with coronary heart disease were selected as research objects, and were divided into the ACS group (84 cases) and the stable angina pectoris (SAP)(96 cases) according to the severity of the disease.According to the incidence of major adverse cardiovascular events (MACE) during the follow-up period of 12 months, ACS patients were divided into event sub-group (n=36) and non-event sub-group (n=48).CCS, serum Hcy, high-sensitivity C-reactive protein (hs-CRP), low-density lipoprotein cholesterol (LDL-C), fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c) of patients in two groups were compared.The correlation between CCS and serum Hcy level in ACS patients was analyzed.The main risk factors of MACE in ACS patients were analyzed after 12 months of follow-up.The value of CCS and serum Hcy level in predicting prognosis of ACS patients at 12 months follow-up was evaluated by receiver operating characteristic (ROC) curve.
The serum levels of Hcy, hs-CRP, LDL-C, FPG and HbA1c in the ACS group were significantly higher than those in the SAP group, while the CCS was significantly lower than that in the SAP group (P < 0.05).CCS was negatively correlated with serum Hcy level in ACS patients (P < 0.05).The CCS of ACS patients in the event sub-group was significantly lower than that in the non-event sub-group, and the serum Hcy level was significantly higher than that in the non-event sub-group (P < 0.05).Serum Hcy was a risk factor for MACE in ACS patients followed up for 12 months (OR=2.872, P=0.020), and CCS was a protective factor (OR=0.459, P=0.011).The cut-off value of serum Hcy was 21.5 μmol/L, and the cut-off value of CCS was 410.0, the area under the curve (AUC) of joint prediction was 0.822, the sensitivity was 86.3%, and the specificity was 80.6%.
The combination of CCS and serum Hcy level has good accuracy in evaluating the short-term outcome of ACS patients.
[1] |
ANDO H, AMANO T, MATSUBARA T, et al. Comparison of tissue characteristics between acute coronary syndrome and stable angina pectoris. An integrated backscatter intravascular ultrasound analysis of culprit and non-culprit lesions[J]. Circ J, 2011, 75(2): 383-390. doi: 10.1253/circj.CJ-10-0815
|
[2] |
PUCHNER S B, MAYRHOFER T, PARK J, et al. Differences in the association of total versus local coronary artery calcium with acute coronary syndrome and culprit lesions in patients with acute chest pain: the coronary calcium paradox[J]. Atherosclerosis, 2018, 274: 251-257. doi: 10.1016/j.atherosclerosis.2018.04.017
|
[3] |
FOSCOLOU A, RALLIDIS L S, TSIREBOLOS G, et al. The association between homocysteine levels, Mediterranean diet and cardiovascular disease: a case-control study[J]. Int J Food Sci Nutr, 2019, 70(5): 603-611. doi: 10.1080/09637486.2018.1547688
|
[4] |
樊刚, 李波, 董莉, 等. 血管内超声与64排螺旋CT冠状动脉CTA对冠脉钙化病变定性、定量检测价值比较[J]. 中国CT和MRI杂志, 2021, 19(1): 90-92. https://www.cnki.com.cn/Article/CJFDTOTAL-CTMR202101031.htm
|
[5] |
中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 慢性稳定性心绞痛诊断与治疗指南[J]. 中华心血管病杂志, 2007, 35(3): 195-206. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHXX200703001.htm
|
[6] |
中国医师协会急诊医师分会, 中华医学会心血管病学分会, 中华医学会检验医学分会. 急性冠脉综合征急诊快速诊疗指南[J]. 中华危重症医学杂志: 电子版, 2016, 9(2): 73-80. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWZD201602001.htm
|
[7] |
BITTNER D O, TAKX R A P, STAZIAKI P V, et al. Identification of coronary artery calcification can optimize risk stratification in patients with acute chest pain[J]. Int J Cardiol, 2017, 249: 473-478. doi: 10.1016/j.ijcard.2017.06.119
|
[8] |
王秀荣, 颜秉菊. 不同方法对急性冠状动脉综合征患者近期预后的预测价值[J]. 实用临床医药杂志, 2021, 25(07): 75-80. https://www.cnki.com.cn/Article/CJFDTOTAL-XYZL202107019.htm
|
[9] |
ADAMSON P D, WILLIAMS M C, DWECK M R, et al. Guiding therapy by coronary CT angiography improves outcomes in patients with stable chest pain[J]. J Am Coll Cardiol, 2019, 74(16): 2058-2070. doi: 10.1016/j.jacc.2019.07.085
|
[10] |
KOOPMANN M, HINRICHS L, OLLIGS J, et al. Cardiac computed tomography in patients with symptomatic new-onset atrial fibrillation, rule-out acute coronary syndrome, but with intermediate pretest probability for coronary artery disease admitted to a chest pain unit[J]. Eur J Med Res, 2018, 23(1): 6. doi: 10.1186/s40001-018-0303-3
|
[11] |
BRAININ P, OLSEN F J, LASSEN M C H, et al. Postsystolic shortening on echocardiography as a gateway to cardiac computed tomography in patients with suspected stable angina pectoris[J]. Int J Cardiovasc Imaging, 2020, 36(2): 309-316. doi: 10.1007/s10554-019-01724-4
|
[12] |
王志文, 王倩, 朱纯生. 64排CT冠脉成像在冠心病中的临床诊断价值分析[J]. 影像研究与医学应用, 2021, 5(13): 225-226. https://www.cnki.com.cn/Article/CJFDTOTAL-YXYY202113116.htm
|
[13] |
王忠启, 钟桥维, 廖宇光. 64-DSCTCA扫描技术对冠状动脉狭窄的诊断价值分析[J]. 现代医用影像学, 2020, 29(06): 1081-1082+1088. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYY202006027.htm
|
[14] |
SIMON J, SZÁRAZ L, SZILVESZTER B, et al. Calcium scoring: a personalized probability assessment predicts the need for additional or alternative testing to coronary CT angiography[J]. Eur Radiol, 2020, 30(10): 5499-5506. doi: 10.1007/s00330-020-06921-7
|
[15] |
SADAKA M A, EL-SHARKAWY E M, SOBHY M A, et al. Long-term prognostic implication of coronary plaque characterization as detected by 64-multidetector computed tomography in Egyptian population[J]. Egypt Heart J, 2017, 69(1): 63-70. doi: 10.1016/j.ehj.2016.08.003
|
[16] |
LI X X, BU S, DONG B, et al. The predictive values of GGT and Hcy in the risk stratifications and prognoses of NSTE-ACS patients[J]. Am J Transl Res, 2021, 13(8): 9269-9277.
|
[17] |
ZHU M J, MAO M, LOU X S. Elevated homocysteine level and prognosis in patients with acute coronary syndrome: a meta-analysis[J]. Biomarkers, 2019, 24(4): 309-316. doi: 10.1080/1354750X.2019.1589577
|
[18] |
MIÑANA G, GIL-CAYUELA C, FÁCILA L, et al. Homocysteine and long-term recurrent infarction following an acute coronary syndrome[J]. Cardiol J, 2021, 28(4): 598-606. doi: 10.5603/CJ.a2020.0170
|
[19] |
ZHAO Y F, ZHANG J. Clinical implication of homocysteine in premature acute coronary syndrome female patients: its distribution and association with clinical characteristics and major adverse cardiovascular events risk[J]. Medicine, 2021, 100(18): e25677. doi: 10.1097/MD.0000000000025677
|
[20] |
程宝香, 曹雷. 冠状动脉粥样硬化心脏病患者血清同型半胱氨酸和超敏C反应蛋白表达特点及临床意义[J]. 实用临床医药杂志, 2020, 24(06): 94-97. https://www.cnki.com.cn/Article/CJFDTOTAL-XYZL202006027.htm
|
[21] |
马强. 冠心病介入治疗后运用降同型半胱氨酸疗法的疗效及对患者血脂水平的影响[J]. 中国医学工程, 2022, 30(04): 67-71. https://www.cnki.com.cn/Article/CJFDTOTAL-YCGC202204017.htm
|
[22] |
WEI M, WANG L, LIU Y S, et al. Homocysteine as a potential predictive factor for high major adverse cardiovascular events risk in female patients with premature acute coronary syndrome[J]. Medicine, 2019, 98(47): e18019. doi: 10.1097/MD.0000000000018019
|
[23] |
SUN J Y, HAN W, WU S J, et al. Associations between hyperhomocysteinemia and the presence and severity of acute coronary syndrome in young adults ≤ 35 years of age[J]. BMC Cardiovasc Disord, 2021, 21(1): 47. doi: 10.1186/s12872-021-01869-y
|
[24] |
周茜, 白洁, 张晶. 血清同型半胱氨酸水平与冠心病严重程度关联分析[J]. 公共卫生与预防医学, 2022, 33(03): 146-149. https://www.cnki.com.cn/Article/CJFDTOTAL-FBYF202203034.htm
|
[25] |
高伟杰, 黑耀宗, 王飞. 血清神经元特异性烯醇化酶同型半胱氨酸联合检测对急性脑梗死合并冠状动脉粥样硬化性心脏病患者的诊断及病情严重程度判断的临床意义[J]. 中国药物与临床, 2022, 22(01): 13-16. https://www.cnki.com.cn/Article/CJFDTOTAL-YWLC202201004.htm
|
[26] |
VERDOIA M, ROLLA R, NEGRO F, et al. Homocysteine levels and platelet reactivity in coronary artery disease patients treated with ticagrelor[J]. Nutr Metab Cardiovasc Dis, 2020, 30(2): 292-299. doi: 10.1016/j.numecd.2019.09.018
|