Introduction: Elevated level of plasma homocysteine has been demonstrated to be an independent risk factor for the development of coronary artery disease. The effects of plasma homocysteine have been demonstrated to be due to its highly atherogenic and prothrombotic properties. The current study aims to establish the association between elevated homocysteine level and the extent of myocardial injury measured by cardiac troponin-I and ejection fraction in patients admitted with acute coronary syndrome.
Subjects and Methods: This was a cross sectional, open labeled, hospital based study conducted on 200 patients admitted with acute coronary syndrome in the coronary care unit of J N Medical College, AMU, Aligarh, India, during October, 2013 to November, 2014. Informed consent was taken from all patients. A detailed history was taken and a thorough clinical examination was carried out. Cardiac troponin- I (cTI) was measured after 10 to 12 hours of onset of symptoms. Echocardiography was carried out in all patients.
Results: Of the patients with ACS, 62 (31%) had unstable angina, 52 (26%) had NSTEMI and 86 (43%) had STEMI. The mean homocysteine level of the study population was 37.65±12.8 μmol/L. Significant positive correlation was found between Serum Troponin-I level and homocysteine level (P<0.001). Also, a positive correlation was found between serum homocysteine levels and ejection fraction. The R square for this relationship was 0.244, with a p value of <0.001.
Conclusion: Serum homocysteine is associated with increased myocardial injury which has been quantified in the current study by serum cardiac troponin-I levels and ejection fraction, which are independent markers of the extent of myocardial damage in patients of acute coronary syndrome.

Keywords: Homocysteine, troponin, acute coronary syndrome.