The influence of established genetic variation in the haemostatic system on clinical restenosis after percutaneous coronary interventions.
Since activation of the haemostatic system is an important feature of the wound healing response triggered by arterial injury, variations in genes involved in thrombus formation may play a role in restenosis after percutaneous coronary interventions (PCI). Therefore, our aim was to examine the relationship between polymorphisms that are known to play a role in the haemostatic system and the risk of clinical restenosis in the GENetic DEterminants of Restenosis (GENDER) study, a multicenter prospective study design that enrolled 3,104 consecutive patients after successful PCI. Target vessel revascularization (TVR) was the primary endpoint. All patients were genotyped for six polymorphisms in the Factor II, Factor V, Factor VII and PAI-1 genes. The PAI-1 4G variant was associated with an increased risk of TVR. When compared to 5G/5G homozygotes, heterozygous patients were at higher risk for TVR (HR: 1.46, 95% CI: 1.05-2.03), whereas patients with the 4G/4G genotype had an even further increased risk (HR: 1.69, 95% CI: 1.19-2.41). In contrast, the factor V 506Gln (factor V Leiden) amino acid substitution was associated with a decreased risk of TVR (HR: 0.41, 95% CI: 0.19-0.86). Our findings indicate that polymorphisms in the factorV and PAI-1 genes may play a role in the process of restenosis.
Leiden University Medical Center, Department of Cardiology, C5-P, Albinusdreef 2, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
Douwe
D
Pons
Pascalle S
PS
Monraats
Moniek P M
MP
de Maat
Nuno M M
NM
Pires
Paul H A
PH
Quax
Bart J M
BJ
van Vlijmen
Frits R
FR
Rosendaal
Aeilko H
AH
Zwinderman
Pieter A F M
PA
Doevendans
Johannes
J
Waltenberger
Robbert J
RJ
de Winter
René A
RA
Tio
Rune R
RR
Frants
Arnoud
A
van der Laarse
Ernst E
EE
van der Wall
J Wouter
JW
Jukema
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D023903:Coronary Restenosis / Q000097:blood / Q000235:genetics*; D023921:Coronary Stenosis / Q000235:genetics / Q000628:therapy*; D048909:Diabetes Complications / Q000235:genetics; D005165:Factor V / Q000235:genetics*; D005167:Factor VII / Q000235:genetics; D005260:Female; D005500:Follow-Up Studies; D020022:Genetic Predisposition to Disease; D006487:Hemostasis / Q000235:genetics*; D006579:Heterozygote; D006720:Homozygote; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010641:Phenotype; D017395:Plasminogen Activator Inhibitor 1 / Q000235:genetics*; D011110:Polymorphism, Genetic; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011516:Prothrombin / Q000235:genetics; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
D017395:Plasminogen Activator Inhibitor 1; C051321:SERPINE1 protein, human; C095381:factor V Leiden; D005165:Factor V; D005167:Factor VII; D011516:Prothrombin