Clinical Investigations: Interventional Cardiology
A1166C polymorphism of the angiotensin II type 1 receptor gene and risk of adverse events after coronary catheter interventions

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Abstract

Background Contradictory reports exist concerning the role of the angiotensin II type 1 receptor A1166C polymorphism as a coronary risk factor. Moreover, it is unknown whether the A1166C polymorphism is associated with thrombotic complications after coronary catheter interventions. Methods We investigated the role of the A1166C polymorphism as a risk factor in 1000 patients with coronary artery disease (CAD) and in 1000 age- and sex-matched controls. A total of 649 patients receiving interventions (270 coronary angioplasty, 102 atherectomy, and 277 stenting) were investigated for a 30-day composite end point including target vessel revascularization, myocardial infarction, or death. Results The composite end point was reached by 42 patients (6.5%) without evidence that the C allele was associated with excess procedural risk (odds ratio 0.93; 95% confidence interval 0.79-1.75; P =.82). Further analyses by device failed to show linkage with adverse events complicating coronary angioplasty, atherectomy, and stenting. Moreover, in the entire CAD group (n = 1000), the polymorphism even showed a trend to underrepresentation (odds ratio 0.83; 95% confidence interval 0.69-1.004, P =.054). Conclusions These results indicate that the A1166C polymorphism neither represents a risk factor for adverse events complicating coronary interventions nor seems to have significant impact on further long-term processes such as development and severity of CAD. (Am Heart J 2000;140:170-5.)

Section snippets

Methods

This study was designed to investigate genetic traits as putative risk factors of CAD and of adverse events complicating coronary catheter interventions. This study, with a multiple end point, enrolled 1000 consecutive patients with CAD admitted for elective or emergency angiography at the Charité University Medical Center between October 1995 and January 1997. An additional 1000 patients also admitted to this hospital served as controls. They were matched by age (± 3 years), sex, and time of

Study group characteristics

Table I lists baseline characteristics of cases and controls.

. Baseline characteristics of cases and controls

Empty CellCases (n = 1000)Controls (n = 1000)P value
Age (y)*60.660.5
(55.1, 67.1)(54.5, 66.5).48
Female (%)24.124.1
History (%)
 Diabetes22.811.4<.001
 Smoking44.035.2<.001
 Hypertension55.235.9<.001
 Hypercholesterolemia52.730.3<.001
 Age of manifestation <40 years6.8
Angina (%)
 Stable66.5
 Unstable14.4
Myocardial infarction (%)66.9
 Acute9.1
 History of57.8
Severity of CAD (%)
 1-Vessel29.7
 2-Vessel36.5
 3-Vessel33.8
*Values

Discussion

An increasing number of genetic studies on the association of polymorphisms of the RAS and CAD have been published during recent years. Instead of shedding light on the role of the RAS in development of chronic or acute manifestation of CAD, however, contributions to the literature remain contradictory. Nakauchi et al4 on the one hand, suggested that the A1166C polymorphism in Japanese patients was related to severity of coronary stenosis. The Coronary Disease and Angiotensin-Converting Enzyme

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Reprint requests: Karl Stangl, MD, Medizinische Klinik und Poliklinik mit Schwerpunkt Kardiologie, Angiologie und Pneumologie, Campus Mitte, Charité, Schumannstr. 20/21, D–10117 Berlin, Germany. E-mail: [email protected]

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