DNA Polymorphisms of the Renin-Angiotensin System and Risk of Restenosis after Coronary Balloon Angioplasty

腎素－血管緊縮素系統之DNA多型性對冠狀動脈汽球擴張術後再狹窄之影響

陳國慶(Kuo-Chin Chen) ； 許寬立(Kwan-Lih Hsu) ； 黃端仁(Juey-Jen Hwang) ； 曾春典(Chuen-Den Tseng) ； 曾淵如(Yung-Zu Tseng) ； 江福田(Fu-Tien Chiang)

《Acta Cardiologica Sinica》 22卷2期 (2006/06) Pp. 58-66

摘要

Background and Purpose: DNA polymorphisms of component genes in RAS were reported to modulate the process of post-PTCA restenosis. This study was designed to assess the influence of eight gene polymorphisms involved at different steps of the renin-angiotensin system (RAS) enzymatic cascade on post-percutaneous transluminal coronary angioplasty (PTCA) restenosis simultaneously. We think systemic analysis of predisposing alleles in RAS will clarify our understanding of mechanisms derived from the conflicting results of previous studies. Methods: This prospective study included 290 Chinese patients who underwent a successful angioplasty procedure and follow-up angiography (mean 42.4±14.5 months) if angina recurred with positive noninvasive stress tests. Restenosis was defined as a more than 50% diameter stenosis at the previously treated vessel site.
Results: Among these gene polymorphisms, only ACE D allele was significantly associated with post-PTCA restenosis in univariate (D/D 72.5%, D/I 54.4%, I/I 47.5%, p value test for trend＜0.01) and multivariate (p value test for trend＜0.01) analysis. One novel finding in our study is that the effect of ACE D allele on restenosis is reversed by AGT-M174 allele (p value to test for the interaction term=0.03).
Conclusions: Our results indicate ACE D allele increases the risk of post-PTCA restenosis, and this risk is modified by the coexistence of AGT-M174 allele in Chinese patients. Gene-gene interactions have increasing importance in the post-genome era and may explain contradictory results in previous studies.

關鍵字

腎素－血管緊縮素系統 ； 多型性 ； 冠狀動脈汽球擴張術 ； 再狹窄

並列摘要

Background and Purpose: DNA polymorphisms of component genes in RAS were reported to modulate the process of post-PTCA restenosis. This study was designed to assess the influence of eight gene polymorphisms involved at different steps of the renin-angiotensin system (RAS) enzymatic cascade on post-percutaneous transluminal coronary angioplasty (PTCA) restenosis simultaneously. We think systemic analysis of predisposing alleles in RAS will clarify our understanding of mechanisms derived from the conflicting results of previous studies. Methods: This prospective study included 290 Chinese patients who underwent a successful angioplasty procedure and follow-up angiography (mean 42.4±14.5 months) if angina recurred with positive noninvasive stress tests. Restenosis was defined as a more than 50% diameter stenosis at the previously treated vessel site.
Results: Among these gene polymorphisms, only ACE D allele was significantly associated with post-PTCA restenosis in univariate (D/D 72.5%, D/I 54.4%, I/I 47.5%, p value test for trend＜0.01) and multivariate (p value test for trend＜0.01) analysis. One novel finding in our study is that the effect of ACE D allele on restenosis is reversed by AGT-M174 allele (p value to test for the interaction term=0.03).
Conclusions: Our results indicate ACE D allele increases the risk of post-PTCA restenosis, and this risk is modified by the coexistence of AGT-M174 allele in Chinese patients. Gene-gene interactions have increasing importance in the post-genome era and may explain contradictory results in previous studies.

並列關鍵字

Renin-angiontensin system ； Polymorphism ； PTCA ； Restenosis