title: Relation between the insertion/deletion polymorphism of the angiotensin I converting enzyme gene and restenosis after coronary stenting.
abstract: BACKGROUND
  Observations with intravascular ultrasound demonstrated that neointimal hyperplasia is the predominant factor responsible for in-stent restenosis. Experimental data suggest that angiotensin I converting enzyme (ACE) plays a role in the thickening of neointima after balloon denudation. Insertion/deletion (I/D) polymorphism of the ACE gene is significantly associated with plasma level of ACE and subjects with D/D genotype have significantly higher plasma levels of ACE than normal.
  
  
  OBJECTIVE
  To investigate whether this polymorphism influences the risk of restenosis after coronary stenting.
  
  
  METHODS
  We genotyped 158 patients who had undergone single-vessel coronary stenting for the ACE I/D polymorphism.
  
  
  RESULTS
  Of the 158 patients, 56 (35%) had the D/D genotype, 71 (45%) had the I/D genotype and 31 (20%) had the I/I genotype. Prevalences of genotypes were compatible with Hardy-Weinberg equilibrium and distributions of ACE genotype among patients and 132 healthy controls from the same geographic area did not differ. At follow-up (after a median duration of 5.4 months), overall rates of angiographic restenosis and of revascularization of target lesion (RTL) were 32.3 and 22.8%, respectively. Of 51 patients with angiographic restenosis, 31 (60.8%) had focal and 20 (39.2%) had diffuse patterns of restenosis. Diffuse in-stent restenosis was significantly more prevalent among patients with D/D genotype (P = 0.016). Multiple stepwise logistic regression analysis identified ACE I/D polymorphism as the independent predictor of angiographic restenosis and RTL. Relative risk of angiographic restenosis was 6.29 [95% confidence interval (CI), 1.80-22.05, P = 0.0004] for D/D genotype and 3.88 (95% CI 1.11-13.12, P = 0.029) for I/D genotype, whereas relative risk of RTL was 7.44 (95% CI 1.60-34.58, P = 0.01) for D/D genotype and 3.88 (95% CI 0.083-18.15, P = 0.085) for I/D genotype.
  
  
  CONCLUSIONS
  The ACE I/D polymorphism is significantly associated with risk of angiographic and clinical restenosis after coronary stenting. Angiographic pattern of restenosis is also significantly associated with I/D polymorphism, diffuse type being more prevalent among subjects with D/D genotype.
authors.affiliation: University of Ankara, Ankara, Turkey. gulec99@yahoo.com
authors.forename: A
authors.initials: A
authors.lastname: Gürlek
authors.forename: S
authors.initials: S
authors.lastname: Güleç
authors.forename: H
authors.initials: H
authors.lastname: Karabulut
authors.forename: I
authors.initials: I
authors.lastname: Bokesoy
authors.forename: E
authors.initials: E
authors.lastname: Tutar
authors.forename: G
authors.initials: G
authors.lastname: Pamir
authors.forename: A
authors.initials: A
authors.lastname: Alpman
authors.forename: R
authors.initials: R
authors.lastname: Toydemir
authors.forename: O
authors.initials: O
authors.lastname: Aras
authors.forename: D
authors.initials: D
authors.lastname: Oral
mesh_terms: D017023:Coronary Angiography; D003327:Coronary Disease / Q000235:genetics* / Q000628:therapy; D004251:DNA Transposable Elements; D005260:Female; D017353:Gene Deletion; D005838:Genotype; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D007703:Peptidyl-Dipeptidase A / Q000097:blood / Q000235:genetics*; D011110:Polymorphism, Genetic; D012008:Recurrence; D015607:Stents
chemical_list: D004251:DNA Transposable Elements; D007703:Peptidyl-Dipeptidase A