Homocysteine as a Predictor of Early Neurological Deterioration in Acute Ischemic Stroke

• Published in: Stroke (1970) Vol. 45; no. 3; pp. 871 - 873
• Main Authors: Kwon, Hyung-Min, Lee, Yong-Seok, Bae, Hee-Joon, Kang, Dong-Wha
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.03.2014
• Subjects: Aged; Aspirin - therapeutic use; Biological and medical sciences; Biomarkers - blood; Brain Ischemia - pathology; C-Reactive Protein - analysis; Disease Progression; Double-Blind Method; Female; Glycated Hemoglobin A - analysis; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Homocystine - blood; Humans; Hyperhomocysteinemia - blood; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Nervous System - pathology; Neurology; Platelet Aggregation Inhibitors - therapeutic use; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Prospective Studies; Risk Factors; Stroke - pathology; Tetrazoles - therapeutic use; Vascular diseases and vascular malformations of the nervous system; homocysteine; Cerebral infarction; Thiol; Stroke; Nervous system diseases; Cardiovascular disease; Cerebral disorder; Sulfur containing aminoacid; Vascular disease; Homocystein; Central nervous system disease; Brain ischemia; Cerebrovascular disease; cerebral infarction; stroke
• ISSN: 0039-2499; 1524-4628; 1524-4628
• DOI: 10.1161/STROKEAHA.113.004099

Hyperhomocysteinemia is a well-known risk factor for vascular disease. However, its action, mechanism, and role in the acute phase of stroke have not been determined. We tried to determine whether an association existed between elevated serum homocysteine levels and early neurological deterioration (END) in patients with acute ischemic stroke. We performed a secondary analysis from the Cilostazol in Acute Ischemic Stroke Treatment (CAIST) trial, which was a double-blinded, randomized, multicenter trial, assessing the noninferiority of cilostazol over aspirin within 48 hours of an acute ischemic stroke. END was defined as an increase of ≥1 point in motor power or an increase of ≥2 points in the total National Institute of Health Stroke Scale score within 7 days. The mean (±SD) serum homocysteine level was 11.4±4.7 μmol/L. Of the 396 patients studied, 57 (14.4%) patients worsened during the 7 days after inclusion. Most (68%) of the END cases occurred within the first 24 hours after treatment. High levels (>10.3 μmol/L) of serum homocysteine were independent predictors for END (third quartile odds ratio, 3.45; 95% confidence intervals, 1.25-9.50; P=0.016; fourth quartile odds ratio, 3.36; 95% confidence intervals 1.18-9.52; P=0.023) in multivariate analysis. Patients with acute stroke with elevated serum homocysteine levels are at an increased risk for END.