Roguin Ariel, Koch Werner, Kastrati Adnan, Aronson Doron, Schomig Albert, Levy Andrew P
Technion-Israel Institute of Technology, Haifa, Israel.
Diabetes Care. 2003 Sep;26(9):2628-31. doi: 10.2337/diacare.26.9.2628.
The goal of this study was to determine whether the haptoglobin (Hp) genotype was predictive of restenosis and major adverse cardiac events (MACEs) after percutaneous transluminal coronary angioplasty (PTCA) in individuals with diabetes.
A consecutive series of 935 diabetic patients treated with oral agents and/or insulin were followed for 1 year after PTCA. The primary study end point was angiographic restenosis, MACEs and secondary study end points were defined as target vessel revascularization, myocardial infarction, and death. Two alleles exist at the Hp gene locus, denoted 1 and 2. The Hp genotype (Hp 1-1, Hp 2-1, or Hp 2-2) was determined by PCR.
In multivariate analysis controlling for all known determinants of outcome after PTCA, we found that the Hp genotype was a highly significant independent predictor of MACEs in the 1-year period after PTCA in individuals with diabetes. This was predominantly due to differences in the risk of myocardial infarction during that period: Hp 1-1, 0 of 129 (0%); Hp 2-1, 20 of 424 (4.7%); and Hp 2-2, 32 of 382 (8.4%); P < 0.0001.
The Hp genotype seems to be highly predictive of adverse cardiac events, particularly myocardial infarction, in the 1-year period after PTCA. Determination of the Hp genotype may be useful in the evaluation of new therapies to reduce cardiovascular risk after PTCA.
本研究旨在确定在糖尿病患者经皮腔内冠状动脉成形术(PTCA)后,触珠蛋白(Hp)基因型是否可预测再狭窄和主要不良心脏事件(MACE)。
对935例接受口服药物和/或胰岛素治疗的糖尿病患者在PTCA后进行了为期1年的随访。主要研究终点为血管造影再狭窄、MACE,次要研究终点定义为靶血管血运重建、心肌梗死和死亡。Hp基因位点存在两个等位基因,分别记为1和2。通过聚合酶链反应(PCR)确定Hp基因型(Hp 1-1、Hp 2-1或Hp 2-2)。
在对PTCA后所有已知结局决定因素进行多变量分析时,我们发现Hp基因型是糖尿病患者PTCA后1年内MACE的高度显著独立预测因子。这主要是由于该时期心肌梗死风险的差异:Hp 1-1,129例中有0例(0%);Hp 2-1,424例中有20例(4.7%);Hp 2-2,382例中有32例(8.4%);P<0.0001。
Hp基因型似乎对PTCA后1年内的不良心脏事件,尤其是心肌梗死具有高度预测性。确定Hp基因型可能有助于评估降低PTCA后心血管风险的新疗法。