[New approach to interventional cardiology treatment with personalized medicine].
Structural and functional genomics enable identification of genes involved in incorrect response or resistance to treatment. These techniques improve prevention and specialized treatment in patients with cardiovascular disease (CVD), especially after acute myocardial infarction.


OBJECTIVE
To summarize and present the most recent information about individual genetic factors involved in treatment failure after acute coronary syndromes (ACS) and describe new frontiers in development of personalized medicine during every day practice. The molecular basis and prediction value of these studies confirm their importance for the future of invasive cardiology.


METHODS
Based on Medline database, a search of recent studies and trials published between 2000 and 2007 concerning personalized medicine in ACS treatment was performed.


RESULTS
Analyzed literature indicate possibilities of improving effective treatment and prevention of CVD based on study of structure of genome, epidemiological factors and implementation of these findings into everyday clinical practice. Clinical studies concerning ACE polymorphism, revealed significant relationship between the DD allele in ACE genome and increased mortality or need for heart transplantation. The risk was significantly higher in patients without beta-blocker treatment. Clopidogrel treatment is proven to be ineffective in 10-30% of patients. The impaired activity of CYP3A4 enzyme, changing in individuals is considered to be the reason for inadequate response to clopidogrel treatment. Use of the enzyme activators such as rifampicine improves the outcomes. New generations of antiplatelet drugs such as AZD6140, which do not need to covert to an active form are under investigation. Total resistance to aspirin treatment was proven in 5.5-9.5% of patients, but 23.8% presented suboptimal response to therapy.
Podolec
Jakub
J
Zakład Hemodynamiki i Angiokardiografii, Instytut Kardiologii Uniwersytet Jagielloński Collegium Medium, Kraków. jakubpodolec@poczta.onet.pl
Gajos
Grzegorz
G
Budziaszek
Łukasz
Ł
Czaniecka
Małgorzata
M
Kleczkoska
Alicja
A
Zmudka'
Krzysztof
K
D054058:Acute Coronary Syndrome / Q000235:genetics* / Q000517:prevention & control*; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D000077144:Clopidogrel; D004351:Drug Resistance / Q000235:genetics*; D006402:Hematologic Diseases; D006801:Humans; D009203:Myocardial Infarction / Q000235:genetics / Q000517:prevention & control; D010548:Personal Health Services / Q000379:methods*; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D017211:Treatment Failure
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin