Serum Homocysteine and High-Sensitivity C-Reactive Protein as Predictors of Severity in Acute Coronary Syndrome: A Prospective Observational Study

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Acute coronary syndrome (STEMI, NSTEMI, or unstable angina) (n=180). Intervention: Serum high-sensitivity C-reactive protein (hs-CRP) and serum homocysteine vs. Lower biomarker concentrations (continuous analysis per doubling of hs-CRP and per 5 µmol/L of homocysteine). Primary outcome: High angiographic coronary artery disease severity (defined as Gensini score ≥40) (OR 2.52, 95% CI 1.55-4.09, p=<0.001).

Q: What does this research mean for the field?

Serum hs-CRP is an independent predictor of high angiographic disease severity in acute coronary syndrome, whereas homocysteine exhibits a borderline independent association while offering complementary predictive value. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To assess the relationship between serum homocysteine, high-sensitivity C-reactive protein (hs-CRP), and angiographic disease severity in acute coronary syndrome.

Nityanand Rao Patil; Patil Archana; Jai Bharat Bhalke

doi:10.37022/wjcmpr.v8i3.451

October 15, 2026World Journal of Current Medical and Pharmaceutical ResearchOpen Access

Serum Homocysteine and High-Sensitivity C-Reactive Protein as Predictors of Severity in Acute Coronary Syndrome: A Prospective Observational Study

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Key result

Serum hs-CRP independently predicted high angiographic severity (Gensini ≥40; adjusted OR 2.52 per doubling, p<0.001), whereas homocysteine showed a borderline association (OR 1.38, p=0.050).

Why the study?

Homocysteine and high-sensitivity C-reactive protein (hs-CRP) may reflect complementary pathways in coronary atherosclerosis, prompting evaluation of their relationship with angiographic severity in acute coronary syndrome (ACS).

Do serum homocysteine and hs-CRP levels predict angiographic coronary artery disease severity (Gensini score ≥40) in patients admitted with acute coronary syndrome?

Key Points

To assess the relationship between serum homocysteine, high-sensitivity C-reactive protein (hs-CRP), and angiographic disease severity in acute coronary syndrome.
Conducted a prospective observational study in 180 patients with acute coronary syndrome undergoing coronary angiography and biomarker measurement.
Quantified coronary angiographic disease burden using the Gensini score, defining high severity as a score of ≥40.
Evaluated multivariable associations using logistic regression and assessed model discrimination using receiver operating characteristic curve analysis.
Both biomarkers positively correlated with Gensini score (homocysteine Spearman ρ=0.339, p<0.001; hs-CRP Spearman ρ=0.391, p<0.001) and were higher in patients with high angiographic severity.
On multivariable logistic regression, hs-CRP independently predicted high Gensini severity (adjusted OR 2.52 per doubling, 95% CI 1.55–4.09, p<0.001), while homocysteine showed a borderline association (adjusted OR 1.38 per 5 µmol/L, 95% CI 1.00–1.89, p=0.050).
Adding both biomarkers to clinical risk factors increased the area under the receiver operating characteristic curve from 0.695 to 0.765 (95% CI 0.698–0.830).

Study Design

Type

Observational (n=180)

Multicenter

No

Structured PICO

Do serum homocysteine and hs-CRP levels predict angiographic coronary artery disease severity (Gensini score ≥40) in patients admitted with acute coronary syndrome?

P

Population

180 adults (mean age 60.3 years, 26.7% female) admitted with acute coronary syndrome (STEMI, NSTEMI, or unstable angina) undergoing coronary angiography, excluding those with active infection, severe renal/hepatic dysfunction, or vitamin supplementation, followed through index hospitalization.

E

Exposure

Measurement of serum homocysteine and high-sensitivity C-reactive protein (hs-CRP) levels prior to coronary intervention during index admission

O

Outcome

Angiographic coronary artery disease severity assessed continuously by the Gensini score and categorically as high angiographic severity (Gensini score ≥40) during index hospitalizationsurrogate

Main Result

Odds Ratio: 2.52 (95% CI 1.55–4.09)

p-value: p=<0.001

In patients with acute coronary syndrome, hs-CRP is an independent predictor of severe angiographic disease burden (Gensini score ≥40) and in-hospital MACE, while serum homocysteine provides complementary discrimination of underlying anatomical coronary severity.

Limitations

Single-centre study design
Modest sample size (N=180)
Measurement of biomarkers at a single time point
Potential residual confounding on both hs-CRP and homocysteine levels
Limited statistical power for mortality and in-hospital outcome analyses
Operational categorization of continuous angiographic score using the Gensini ≥40 threshold
Short observation period restricted to index hospitalization
Relatively small number of in-hospital clinical events (25 MACE and 7 deaths)

Implication

hs-CRP may aid ACS severity prediction; extends observational correlations but leaves open prospective outcome trials.

Abstract

Background: Homocysteine and high-sensitivity C-reactive protein (hs-CRP) may reflect complementary pathways involved in coronary atherosclerosis. This study evaluated their relationship with angiographic severity in acute coronary syndrome (ACS). Methods: In this prospective observational study, 180 patients with ACS underwent serum homocysteine and hs-CRP measurement and coronary angiography. Disease burden was assessed using the Gensini score, with high severity defined as ≥40. Results: Median homocysteine was 14.45 µmol/L and hs-CRP 6.35 mg/L. Both biomarkers correlated with Gensini score (homocysteine ρ=0.339; hs-CRP ρ=0.391; both p<0.001) and were higher in patients with severe angiographic disease. After adjustment, hs-CRP remained independently associated with high Gensini severity (OR 2.52 per doubling; p<0.001), while homocysteine showed a borderline association (OR 1.38 per 5 µmol/L; p=0.050). Addition of both biomarkers increased AUC from 0.695 to 0.765. Conclusion: hs-CRP was a stronger predictor of angiographic severity, while homocysteine provided complementary prognostic information.

Discussion

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Cite This Study

Patil et al. (2026) conducted an observational in Acute coronary syndrome (STEMI, NSTEMI, or unstable angina) (n=180). Serum high-sensitivity C-reactive protein (hs-CRP) and serum homocysteine vs. Lower biomarker concentrations (continuous analysis per doubling of hs-CRP and per 5 µmol/L of homocysteine) was evaluated on High angiographic coronary artery disease severity (defined as Gensini score ≥40) (OR 2.52, 95% CI 1.55-4.09, p=<0.001). Serum hs-CRP independently predicted high angiographic severity (Gensini ≥40; adjusted OR 2.52 per doubling, p<0.001), whereas homocysteine showed a borderline association (OR 1.38, p=0.050).

synapsesocial.com/papers/6ae28e75cbadf70daf6c4246 https://doi.org/10.37022/wjcmpr.v8i3.451

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Serum Homocysteine and High-Sensitivity C-Reactive Protein as Predictors of Severity in Acute Coronary Syndrome: A Prospective Observational Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Serum Homocysteine and High-Sensitivity C-Reactive Protein as Predictors of Severity in Acute Coronary Syndrome: A Prospective Observational Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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