HoldsUp

Zhang · Cardiovascular drugs and therapy 2019 · systematic review and meta-analysis · n=19 studies (4,340 participants)

Association of Elevated Plasma Homocysteine Level with Restenosis and Clinical Outcomes After Percutaneous Coronary Interventions: a Systemic Review and Meta-analysis.

Cited 13 times in the scientific literature.

Level 3 - non-randomized controlled study

Systematic review and meta-analysis of observational prognostic studies

PubMed 30778807 · doi:10.1007/s10557-019-06866-0 · record verified 2026-08-30

What was done

A systematic review and meta-analysis of PubMed, EMBASE, and Web of Science databases (searched through May 2018; PROSPERO CRD42018096466) evaluated the association between elevated plasma homocysteine (Hcy) levels and outcomes after percutaneous coronary intervention (PCI). Outcomes assessed were restenosis, major adverse cardiac events (MACE), all-cause mortality, cardiac death, non-fatal myocardial infarction (MI), and target lesion revascularization.

What was found

Nineteen articles including 4,340 participants were analyzed: - Restenosis: Higher Hcy was not significantly associated with restenosis (RR = 1.10, 95% CI 0.90–1.33; weighted mean difference = 0.70, 95% CI -0.23 to 1.63). Subgroup analysis indicated no association after stenting, but an apparent increased risk after angioplasty. - Mortality and MACE: Elevated Hcy significantly increased all-cause mortality (RR = 3.19, 95% CI 1.90–5.34, P = 0.000), MACE (RR = 1.51, 95% CI 1.23–1.85, P = 0.000), and cardiac death (RR = 2.76, 95% CI 1.44–5.32, P = 0.000). - Non-fatal MI: Not significantly increased (RR = 1.36, 95% CI 0.89–2.09).

Why it matters

Elevated homocysteine is an important prognostic biomarker for mortality and major adverse cardiac events after PCI, though it does not appear to predict in-stent restenosis.

Limits

Specific cutoffs defining elevated homocysteine were not stated in the abstract. Numerical results for target lesion revascularization and angioplasty-specific restenosis were not provided. Stent types (bare metal vs drug-eluting), patient comorbidities, and adjustments for confounders were not described.

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