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Is evaluation of complex polymorphism helpful in the assessment of prognosis after percutaneous coronary
Tomasz M Rywik1, Małgorzata Szperl, Rafał Płoski
1Department of Heart Failure and Transplantology, Institute of Cardiology, Warsaw, Poland. rywikt@mp.pl
Insights
Genetic factors may influence outcomes after percutaneous coronary intervention (PCI) for coronary artery disease (CAD). However, lipid metabolism risk factors appear to be the primary drivers of long-term prognosis in these patients.
Area of Science:
- Cardiovascular Genetics
- Interventional Cardiology
- Molecular Biology
Background:
- Coronary artery disease (CAD) is a leading cause of cardiovascular mortality.
- Genetic predisposition is suspected to contribute to adverse outcomes following percutaneous coronary intervention (PCI).
Purpose of the Study:
- To investigate the long-term prognostic impact of genetic polymorphisms in patients with stable CAD undergoing PCI.
- Focus on genes involved in the renin-angiotensin system, inflammation, beta-2 adrenergic receptor, nitric oxide, and platelet activity.
Main Methods:
- Study included 110 male patients with stable angina undergoing elective PCI.
- Genotyping utilized polymerase chain reaction and restriction fragment length polymorphism techniques.
- Long-term follow-up data collected via postal questionnaires on survival, myocardial infarction, and revascularization.
Main Results:
- Interleukin-1 receptor antagonist and CD14 polymorphisms differed between patients and controls.
- Patients requiring revascularization post-PCI showed distinct angiotensinogen M235T variant distribution.
- Myocardial infarction occurrence was associated with selectin E variants and elevated triglycerides.
Conclusions:
- While angiotensinogen and selectin E gene polymorphisms may play a role, lipid metabolism risk factors predominantly influence post-PCI prognosis.
- Lipid profiles are critical for managing long-term outcomes in patients after PCI.
Background:
Coronary artery disease (CAD) is a complex disorder accounting for the majority of cardiovascular deaths and morbidity. It is believed that genetic factors explain part of the excessive risk of major adverse cardiac events (MACE) after percutaneous coronary intervention (PCI).
Aim:
To evaluate the influence on long-term prognosis of some genetic polymorphisms affecting renin-angiotensin system, inflammatory response, beta-2 adrenergic receptor, nitric oxide and platelets activity in patients with stable CAD undergoing routine PCI.
Methods:
The study population consisted of 110 consecutive male patients with stable angina undergoing elective, single-vessel PCI. Genotyping was performed by polymerase chain reaction and restriction fragment length polymorphism-based techniques. Follow-up data were obtained by postal questionnaires regarding survival, myocardial infarction and revascularisation procedures. The control group consisted of 78 healthy males.
Results:
Compared to controls, the distribution of polymorphisms among patients differed with regard to interleukin-1 receptor antagonist and CD14 variants. Patients who had PCI during follow-up in comparison with the remaining patients had a similar genetic profile, but higher triglycerides (1.9 vs 1.5 mmol/L, p = 0.01) and atherogenic index (3.8% vs 3.1%, p = 0.03) and lower percentage of HDL (21.8% vs 25.0%, p = 0.02). Among subjects with any revascularisation procedures, a similar clinical profile was observed. However, they differed from those without any procedures regarding the distribution of angiotensinogen M235T variants (MM%/TM%/TT%) 28%/64%/8% vs 19%/50%/31%, p = 0.048. Stratification for myocardial infarction showed association with selectin E variants (AA%/AC%/CC%) 57.1%/28.6%/14.3% vs 78.8%/21.2%/0%, p = 0.055 and higher triglycerides (2.11 vs 1.57 mmol/L, p = 0.055).
Conclusions:
Although we cannot exclude the role of polymorphism in angiotensinogen and selectin E genes, the prognosis of patients post-PCI in our study was mainly influenced by risk factors related to lipid metabolisms.
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