Jose B. Nevado Jr.,
Marcelo B. Severino Imasa
Department of Biochemistry and Molecular Biology, College of Medicine - University of the Philippines Manila
Unstable angina and non-ST elevation myocardial infarction (NSTEMI) are common acute coronary events with serious clinical especially in the first 6 months after onset. This paper aims to determine association of clinical risk factors with the outcomes of non-ST elevation coronary events. One hundred and twenty four Filipino subjects who were included in a randomized controlled trial on folic acid supplementation hadf been interviewed and tested for blood homocysteine levels and lipid profile. Homocysteinemia at level >16 umol/li is associated with mortality (OR 3.71 (Cl: 1.51-9.15), p=<0.001) and composite outcomes (mortality, nonfatal reinfarction, and serious rehospitalization) (OR 2.19(Cl:1.10-4.33),p=0.025) as adjusted for conventional risk factors-smoking, diabetes, hypertension, advaced age, and dyslipidemia. No association was detected for the conventional risk factors. Of the other clinical parameters, previous history of an acute coronary syndrome was associated with mortality (OR 2.49 (1.07-5.80), p=028) and the composite outcomes (OR 2.27 (1.26-4.07) p=0.004), while previous stroke is associated only with the composite outcomes (OR 2.18 (1.25-3.81), p=0.015). NSTEMI is also associated wth greater mortality (OR 3.45 (Cl: 1.02-12.5), p=0.045) and adverse outcomes (OR 2.77 (Cl:1.10-6.99), p=0.030) than intermediate-risk unstable angina . Therefore, increased homocysteine level (>16 umol/li) is associated with mortality and serious nonfatal outcomes in unstable angina and non-ST elevation myocardial infarction, and this is independent of the conventional risk factors. Previous acute coronary syndrome, previous stroke and the occurence of NSTEMI predict significantly predict adverse outcomes.