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National Heart and
Lung Institute, Charing Cross Campus, Imperial College School of
Medicine, and the Cardiology Department of The Hammersmith Hospitals
NHS Trust, London, UK
Correspondence to: Dr M Al-Obaidi, National Heart and Lung Institute, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK m.al-obaidi{at}rbh.nthames.nhs.uk
Accepted 13 December
2000
BACKGROUND
Raised plasma homocysteine
is a risk factor for coronary artery disease. Patients with myocardial
infarction or unstable angina show greater activation of coagulation,
greater troponin release, and a worse outcome.
OBJECTIVETo examine variations in
plasma homocysteine concentration in relation to C reactive protein
(CRP) in patients presenting with acute coronary syndromes.
METHODSConsecutive patients
presenting with acute myocardial infarction (22) and unstable angina
pectoris (12) were studied. Plasma samples were obtained on admission
(before clinical intervention), on days 2, 7, and 28, and again six
months after admission. Plasma homocysteine, assayed by high
performance liquid chromatography, and CRP were both determined at the
same time points. Changes were assessed by analysis of variance.
RESULTSCRP concentrations showed a
classical rise on day 2, followed by a gradual decline to normal values
taken at six months from admission in both myocardial infarction
(p < 0.0001) and unstable angina (p = 0.02). Homocysteine
concentrations in myocardial infarction (median, 25th to 75th
interquartile range) were: 11.9 (10.7 to 12.6), 11.5 (9.1 to 13.4),
12.1 (11.4 to 14.1), 12.4 (11.1 to 14.4), and 12.1 (11.2 to
14.0) µmol/l, for days 1, 2, 7, 28, and 180, respectively
(p = 0.02). Significant differences were observed only between day 2 and day 7 (p < 0.05). The final homocysteine measurement was not
different from the admission level. Homocysteine concentrations in
unstable angina did not differ between admission and convalescence
(12.5 (9.1 to 14.5) µmol/l and 12.3 (7.7 to 14.9) µmol/l, respectively).
CONCLUSIONSPlasma homocysteine
concentrations are minimally influenced by acute phase variations with
reliable measurements obtained on admission in patients with myocardial
infarction and unstable angina.
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