Angiotensin I-converting enzyme insertion/deletion polymorphism and cardiac mortality and morbidity after coronary artery bypass graft surgery.
OBJECTIVE
This study was designed to evaluate whether the insertion (I)/deletion (D) polymorphism of the angiotensin I-converting enzyme (ACE) gene is associated with mortality and cardiac morbidity after coronary artery bypass graft surgery (CABG).


RESULTS
The ACE I/D genotype was determined in 249 consecutive patients who underwent CABG. Follow-up information (after 2 years) was obtained in 247 patients (99.2%). The primary end point was total mortality; the secondary end point was mortality from cardiac reasons, or the need for myocardial revascularization (coronary angioplasty or recurrent CABG) during follow-up. At follow-up, total mortality was 9.7% (all patients). None of the 51 patients with the ACE II genotype, 14 of 125 patients with the ACE ID genotype (11.2%), and 10 of 71 with the ACE DD genotype (14.1%) died during follow-up (p < 0.05). The ACE DD genotype, older age, diabetes mellitus, decreased left ventricular ejection fraction, and lack of internal mammary artery graft were independently related to an increased mortality after CABG. The incidence of the secondary end point was 14.5% (all patients): ACE II, 5.8%; ACE ID, 9.4%; ACE DD, 30.3% (p < 0.05). The ACE DD genotype and the presence of a left main coronary artery stenosis >or= 50% were independent predictors for the secondary end point.


CONCLUSIONS
The ACE DD genotype is associated with increased midterm mortality and cardiac morbidity after CABG.
Medical Department B, Ernst Moritz Arndt University Greifswald, Griefswald, Germany. voelzke@mail.uni-greifswald.de
Henry
H
Völzke
Julia
J
Engel
Volker
V
Kleine
Christian
C
Schwahn
Johannes B
JB
Dahm
Lothar
L
Eckel
Rainer
R
Rettig
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000453:epidemiology / Q000401:mortality; D023381:Endpoint Determination; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D007703:Peptidyl-Dipeptidase A / Q000235:genetics*; D011110:Polymorphism, Genetic; D011446:Prospective Studies
D007703:Peptidyl-Dipeptidase A