D allele of the angiotensin I-converting enzyme is a major risk factor for restenosis after coronary stenting.
BACKGROUND
Although intracoronary stent implantation significantly reduces restenosis compared with balloon angioplasty, a minority of patients still develop restenosis predominantly due to neointimal hyperplasia. Experimental studies suggest that the renin-angiotensin system is involved in neointimal hyperplasia after arterial injury. In humans, the plasma and cellular levels of ACE are associated with an I/D genetic polymorphism in the ACE gene, DD patients having higher levels.


RESULTS
We investigated a possible relation between the ACE I/D polymorphism and restenosis in 146 patients who underwent successful implantation of a Palmaz-Schatz stent and had 6-month follow-up angiography. The minimal lumen diameter (MLD) before and after the procedure did not differ significantly among the three groups of genotypes (DD, ID, and II). At follow-up, MLD had a significant inverse relationship to the number of D alleles present (DD, 1.65 +/- 0.71 mm; ID, 1.84 +/- 0.60 mm; II, 2.05 +/- 0.61 mm; P < .007). Late luminal loss during the follow-up period was significantly related to the number of D alleles (DD, 0.89 +/- 0.61 mm; ID, 0.60 +/- 0.52 mm; II, 0.40 +/- 0.53 mm; P < .0001). The relative risk of restenosis (defined as a > 50% diameter stenosis at follow-up) approximated by the adjusted odds ratio was 2.00 per number of D alleles (95% confidence interval, 1.03 to 3.88, P < .04).


CONCLUSIONS
The ACE I/D polymorphism influences the level of late luminal loss after coronary stent implantation. These results suggest that the renin-angiotensin system may be implicated in the pathogenesis of restenosis after coronary stenting.
Amant
C
C
INSERM CJF 95-05, Institut Pasteur de Lille, France.
Bauters
C
C
Bodart
J C
JC
Lablanche
J M
JM
Grollier
G
G
Danchin
N
N
Hamon
M
M
Richard
F
F
Helbecque
N
N
McFadden
E P
EP
Amouyel
P
P
Bertrand
M E
ME
D000368:Aged; D000483:Alleles; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000201:enzymology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D016017:Odds Ratio; D007703:Peptidyl-Dipeptidase A / Q000235:genetics*; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D015607:Stents
D007703:Peptidyl-Dipeptidase A