The effectiveness of the differentiated approach to the choice of double antiplatelet therapeutic depending on the G634C polymorphism of the VEGF-A gene in acute myocardial infarction with ST segment elevation

Abstract

Objective — to evaluate the effectiveness of the differentiated approach to the choice of double antiplatelet therapy depending on the polymorphism G634C (rs2010963) of the VEGF-A gene in patients with acute MI with ST segment elevation.Materials and methods. The investigation involved 135 patients and 30 practically healthy controls. The primary PCI using bare-metal coronary stent (BMS) was performed in 109 patients, form them 26 patients underwent preliminary systemic thrombolysis. Coronary blood flow was restored to all patients at the level of TIMI III. The level of vascular endothelial growth factor-A (VEGF-A) was determined on the first day of the disease and after 6 months by the enzyme immunoassay. The patients were divided into two groups depending on the administered double antiplatelet therapy: acetylsalicylic acid in a dose of 100 mg once a day and clopidogrel in a dose of 75 mg once a day or ticagrelor in a dose of 90 mg twice a day. After 6 months of follow-up, the combined endpoint was assessed (cardiovascular death, repeated myocardial infarction, the onset/progression of heart failure, which required hospitalization).Results. To groups have been isolated depending on the G634C allelic polymorphism (rs 2010963) of the VEGF-A gene: homozygotes for the G (GG) allele (n = 70) and carriers of the C allele (GC + CC) (n = 65). Patients with polymorphism GC + CC showed a higher frequency of reaching the combined endpoint — 20 (30 %) patients versus 9 (12.8 %) in the group with the GG genotype (p = 0.005). In patients with the GG genotype receiving ticagrelor, the number of adverse events was 4 (10.8 %), and in those taking clopidogrel — 5 (15.2 %) (p = 0.588). In the group of GC + CC genotypes that received ticagrelor — 6 (15.4 %) endpoints were recorded, but in the clopidogrel group — 14 (51.8 %) (p = 0.005).Conclusions. The conduction of 6-months double antiplatelet therapy with the use of ticagrelor in the group of GC + CC polymorphism resulted in the reduction of adverse cardiovascular events from 51.8 to 15.4 % (р = 0.002). No difference has been established in the ticagrelor effects in comparison with clopidogrel as regards the onset of adverse events in the carriers of GG allele of polymorph G634C (rs 2010963) gene VEGF-A gene.