Abstract

 
 
 
 Purpose: To evaluate the association between common single nucleotide polymorphisms (SNPs) in angiotensin converting enzyme (ACE) gene and the risk of in-stent restenosis (ISR) and/or the response to angiotensin converting enzyme inhibitor ACEI in individuals with stable coronary artery disease (CAD) after stent implantation.
 Methods: The total population of this study consisted of 200 Egyptian individuals divided into 2 groups - in-stent restenosis (ISR) and non ISR group). Genomic DNA was withdrawn from EDTA whole blood applying a spin column approach and ACE gene insertion/deletion (I/D) polymorphisms were determined by polymerase chain reaction (PCR).
 Results: Carriers of allele D of ACE gene were significantly more liable to ISR occurrence. However, carriers of allele I were significantly more liable to ISR occurrence after administration of ACEI. There is a negative interaction between DD genotype of ACE gene and ACEI administration on ISR after percutaneous coronary intervention (PCI). However, there is a positive interaction between II and ID genotype of ACE gene and ACEI administration on ISR after PCI with bare metal stents (BMS).
 Conclusion: It is beneficial to implement ACEI in therapeutic regimen in individuals with ID or II genotypes of ACE gene, especially with BMS implementation.
 
 
 
Highlights
There is a serious complication after stable coronary artery disease (CAD) or acute coronary syndrome known as In-stent restenosis (ISR)
Based on the allelic frequencies of the ACE gene polymorphism of ISR and non-ISR group, it was observed that the allele D genotype frequencies were significantly more in ISR group than NonISR group (75 % versus 27 %) (p < 0.0001)
This study demonstrated a significant increase in male frequency, length of stent, hypertension, diabetes, CKD and obesity in ISR group relative to Non-ISR group suggesting that these are risk factors for ISR
Summary
There is a serious complication after stable coronary artery disease (CAD) or acute coronary syndrome known as In-stent restenosis (ISR). This stent generation overcomes the preceding disadvantages including ISR[1]. Genes such as ACE gene or eNOS gene may perform a crucial province in improvement of ISR between CAD patients. An important clinical obstacle that should be considered is the alteration of individuals response to drugs which may rely on different factors like body weight, gender, genetics, age, organ function, drug interactions, disease states, culture, lifestyle, smoking and diet [5]. If ISR can be related to SNPs, it may be obvious why the repetition of stent implantation is still required and why genetic screening is needed for these patients
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