-455G/A polymorphism and preprocedural plasma levels of fibrinogen show no association with the risk of clinical restenosis in patients with coronary stent placement.
The effect of preprocedural fibrinogen levels on in-stent restenosis is largely unknown. The -455G/A polymorphism of the fibrinogen beta-gene is associated with baseline plasma level or acute phase increase of fibrinogen. Therefore, we hypothesized that there is a relationship between this polymorphism and preprocedural fibrinogen level and clinical restenosis at follow-up among patients with coronary stent placement. The GENetic DEterminants of Restenosis (GENDER) project is a multicenter follow-up study that enrolled 3,146 consecutive patients after successful percutaneous coronary intervention. A coronary stent was placed in 2,309 patients. Of these, 2,257 (97.7%) patients were successfully genotyped for the -455G/A polymorphism. Plasma fibrinogen levels were measured at baseline in a subpopulation of 623 stented patients with the von Clauss method and patients were grouped into tertiles according to fibrinogen levels. Primary endpoint was target vessel revascularization (TVR); secondary combined endpoint was defined as death presumably from cardiac causes, MI not attributable to another coronary artery than the target vessel, and TVR. No association was observed between the -455G/A polymorphism and TVR or combined endpoint (p=0.99, p=0.97, respectively). Multivariate regression analysis revealed that the risk of TVR and combined endpoint was not higher for patients in the highest tertile for fibrinogen versus the lowest tertile (RR=0.60, 95% CI: 0.26-1.37 for TVR, RR=0.64, 95% CI: 0.29-1.44 for combined endpoint). In conclusion, the presence of -455G/A polymorphism in the fibrinogen beta-gene and preprocedural fibrinogen level is not associated with an increased risk of TVR or combined endpoint in a patient population with coronary stent placement. Therefore, these parameters are not worthwhile for stratifying patients at risk for restenosis pre-stenting.
Monraats
Pascalle S
PS
Department of Cardiology, Leiden University Medical Center, The Netherlands. J.W.Jukema@lumc.nl
Rana
Jamal S
JS
Zwinderman
Aeilko H
AH
de Maat
Moniek P M
MP
Kastelein
John P
JP
Agema
Willem R P
WR
Doevendans
Pieter A F
PA
de Winter
Robbert J
RJ
Tio
René A
RA
Waltenberger
Johannes
J
Frants
Rune R
RR
van der Laarse
Arnoud
A
van der Wall
Ernst E
EE
Jukema
J Wouter
JW
D000368:Aged; D023903:Coronary Restenosis / Q000209:etiology*; D005260:Female; D005340:Fibrinogen / Q000032:analysis* / Q000235:genetics*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D020641:Polymorphism, Single Nucleotide; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012306:Risk; D015607:Stents / Q000009:adverse effects*
D005340:Fibrinogen