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The Insertion/Deletion Polymorphism of the Angiotensin-Converting Enzyme Gene and the Risk for Restenosis After PTCA
1Clinic of Internal Medicine B, Ernst Moritz Arndt University, Greifswald, Germany
Insights
Genetic factors, specifically the angiotensin I-converting enzyme (ACE) I/D genotype, were investigated as a risk factor for restenosis after percutaneous transluminal coronary angioplasty (PTCA). The ACE DD genotype was not found to be an independent predictor of restenosis.
Area of Science:
- Cardiology
- Genetics
- Interventional Cardiology
Background:
- Restenosis limits the long-term success of percutaneous transluminal coronary angioplasty (PTCA).
- Mechanisms underlying restenosis are not fully understood, suggesting potential roles for genetic factors.
- The angiotensin I-converting enzyme (ACE) I/D genotype is a candidate genetic marker for cardiovascular diseases.
Purpose of the Study:
- To investigate the angiotensin I-converting enzyme (ACE) I/D genotype as a potential risk factor for restenosis after successful PTCA.
- To evaluate the association between the ACE I/D genotype and clinical and angiographic predictors of restenosis.
Main Methods:
- A cohort of 511 patients undergoing successful PTCA with follow-up angiography were genotyped for the ACE I/D polymorphism.
- Clinical and angiographic data, including degree of stenosis and lesion severity, were collected.
- Restenosis was defined as >50% progression of stenosis at follow-up angiography.
Main Results:
- One hundred sixty patients (31.3%) developed restenosis.
- A higher prevalence of the ACE DD genotype was observed in the restenosis group compared to the no-restenosis group.
- This association was not statistically significant after adjusting for clinical and angiographic variables. Patients with restenosis had higher pre-PTCA stenosis and lesion severity, and lower post-PTCA residual stenosis.
Conclusions:
- The angiotensin I-converting enzyme (ACE) DD genotype is not an independent risk factor for restenosis following percutaneous transluminal coronary angioplasty (PTCA).
- Clinical and angiographic factors remain significant predictors of restenosis after PTCA.
Abstract:
The therapeutic benefit of percutaneous transluminal coronary angioplasty (PTCA) is limited by restenosis in about 30% of patients. The underlying mechanisms are currently not well understood. Besides clinical and angiographic variables, genetic factors may be involved. We determined the angiotensin I-converting enzyme (ACE) I/D genotype as a possible risk factor for restenosis in 511 consecutive patients who had undergone successful PTCA and follow-up angiography. Clinical and angiographic variables were also considered as possible predictors of restenosis. One hundred sixty patients had restenosis as defined by a greater than 50% progression of residual stenosis of the dilated segment at follow-up angiography. There were significantly more patients with the ACE DD genotype in the restenosis than in the no-restenosis group. This difference did not remain statistically significant in an analysis of covariance that included genetic and clinical variables. Patients who subsequently developed restenosis had a higher degree of stenosis and more severe lesions before PTCA as well as less residual stenosis immediately after PTCA. We conclude that the ACE DD genotype is not an independent risk factor for restenosis after PTCA.