The role of genetics in coronary artery bypass surgery patients under 30 years of age.
OBJECTIVE
We undertook genetic assessment of coronary artery disease (CAD) in 20 patients aged 30 years or less undergoing coronary artery bypass grafting (CABG) surgery, to investigate the prognostic value of pre-defined genes.


METHODS
Twenty patients, who underwent CABG surgery between December 2001 and May 2013, were retrospectively analysed to find out the role their genetic make-up played in their disease. We used three genetic diagnostic tests, the plasminogen activator inhibitor (PAI) -1 gene, the A1/A2 polymorphism of glycoprotein IIIa (GpIIIa) gene, and common polymorphisms of the methylenetetrahydrofolate reductase (MTHFR) gene.


RESULTS
The mean age of patients was 26.35 ± 3.51 (19-30) years, and 90% were male (n = 18). One patient had diabetes, three had hypertension, 11 (55%) had dyslipidaemia and 16 (80%) were smokers. Eight of the patients (40%) had left ventricular ejection fraction (LVEF) < 50%, and functional capacity was poor in only two (10%) patients (NYHA III-IV). Follow up was completed in all patients (100%). We found five homozygous and 11 heterozygous mutations in the MTHFR gene, which predisposes individuals to coronary artery disease or deep-vein thrombosis. Eight patients were found to have a GpIIIa gene polymorphism, which is associated with increased risk of myocardial infarction (MI). Fifteen patients had a polymorphism in the promoter region of the PAI-1 gene, which is a major inhibitor of the fibrinolytic system.


CONCLUSIONS
MTHFR C677T polymorphism, and GpIIIa and PAI-1 genes are risk factors for CAD. In young patients, genetic studies promise to revolutionise early diagnosis, treatment and prevention of CAD and MI.
Cardiovascular Surgery Department, Kartal Kosuyolu Research and Education Hospital, Istanbul, Turkey.
Sabit
S
Sarikaya
Cardiovascular Surgery Department, Kartal Kosuyolu Research and Education Hospital, Istanbul, Turkey.
Ebuzer
E
Aydin
Cardiovascular Surgery Department, Kartal Kosuyolu Research and Education Hospital, Istanbul, Turkey.
Yucel
Y
Ozen
Cardiovascular Surgery Department, Kartal Kosuyolu Research and Education Hospital, Istanbul, Turkey.
Tanil
T
Ozer
Cardiovascular Surgery Department, Kartal Kosuyolu Research and Education Hospital, Istanbul, Turkey.
Kaan
K
Kirali
Cardiovascular Surgery Department, Kartal Kosuyolu Research and Education Hospital, Istanbul, Turkey. Email: muratrabus@yahoo.com.
Murat Bulent
MB
Rabus
D000328:Adult; D017668:Age of Onset; D015897:Comorbidity; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000235:genetics* / Q000503:physiopathology / Q000601:surgery*; D004252:DNA Mutational Analysis; D005260:Female; D020022:Genetic Predisposition to Disease; D006579:Heterozygote; D006720:Homozygote; D006801:Humans; D039661:Integrin beta3 / Q000235:genetics*; D008297:Male; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics*; D009154:Mutation; D010641:Phenotype; D017395:Plasminogen Activator Inhibitor 1 / Q000235:genetics*; D011110:Polymorphism, Genetic; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D016277:Ventricular Function, Left; D055815:Young Adult
D039661:Integrin beta3; D017395:Plasminogen Activator Inhibitor 1; C051321:SERPINE1 protein, human; C573423:MTHFR protein, human; D042965:Methylenetetrahydrofolate Reductase (NADPH2)