Association of ACE gene polymorphisms with cardiovascular events in patients after elective percutaneous coronary interventions

Aim . To reveal the association of the INS/DEL polymorphism of the angiotensinconverting enzyme (ACE) gene with acute and long-term complications of elective percutaneous coronary interventions (PCI). Material and methods . This prospective study included 286 patients with chronic coronary artery disease who underwent elective endovascular myocardial revascularization in accordance with current guidelines. The ACE gene INS/DEL (I/D) polymorphism was determined in patients using polymerase chain reaction. Acute periprocedural complications were recorded. Acute myocardial injury (AMI) was detected in 30,4% of patients. Type 4a acute myocardial infarction developed in 3,1% of patients. A significant decrease in the glomerular filtration rate by more than 30% due to periprocedural acute kidney injury (AKI) was diagnosed in 6,5% of patients. Outcomes of elective PCIs were assessed after 4 years via telephone interviews. Cardiovascular and any-cause mortality was 3,6% and 5,1%, respectively. Acute coronary syndrome during the follow-up period developed in 15,2%, while cerebrovascular accident — in 5,4% of patients. Any-stent thrombosis was detected in 10%, and restenosis ≥30% — in 21,8% of patients. Statistical analysis was carried out using the STATISTICA 10. The odds ratio (OR) was calculated with a 95% confidence interval. Results . Analysis of the association of ACE gene I/D polymorphism with acute and long-term complications of the PCI revealed that the presence of I allele is associated with the risk of periprocedural AKI (p=0,017; OR, 2,627 (1,161- 5,947)), as well as long-term cardiovascular events, vascular complications such as acute coronary syndrome (p=0,045; OR, 1,610 (1,007-2,573)) and stent thrombosis (p=0,01; OR, 2,073 (1,178-3,650)). The presence of genotype II further increases the risk of AKI (p=0,029; OR, 5,138 (1,022-25,824)), any acute clinical complications of PCI (p=0,041; OR, 1,996 (1,024-3,980)), and stent thrombosis (p=0,018, OR, 3,498 (1,178-10,392)). Conclusion . In patients with chronic coronary artery disease, the carriage of allele I and genotype II of the ACE gene I/D polymorphism is associated with the risk of acute clinical complications of elective PCI, periprocedural AKI, as well as the risk of stent thrombosis and acute coronary syndrome within 4-year follow-up period after PCI.