Martínez-Quintana Efrén, Chirino Ricardo, Nieto-Lago Vicente, Pérez-Jiménez Patricia, López-Ríos Laura, Rodríguez-González Fayna
Cardiology Service, Insular-Materno Infantil University Hospital, Las Palmas de Gran Canaria, Spain.
Cardiol J. 2014;21(3):229-37. doi: 10.5603/CJ.a2013.0107. Epub 2013 Aug 30.
Coronary artery disease (CAD) has turned into a prevalent cause of morbi-mortality contributing some polymorphisms in the recurrence of major adverse cardiac events (MACE).
Three hundred and fifty six patients with first myocardial infarction (MI) were followed up during a 60-month period to find out if ACE I/D, AT1R A1166C, PAI-I 4G/5G and GPIIIa a1/a2 polymorphisms, in combination with other classical cardiovascular risk factors, can contribute to the relapse of MACE.
Two hundred and eighty five (80.1%) men and 71 (19.9%) women were followed up after first MI. The primary clinical endpoint, a composite of MACE, was reached in 106 (29.8%) patients. In the Cox univariate survival analysis those risk factors influencing a poorer prognosis were age (p = 0.004), a positive family history of CAD (p = 0.007), diabetes (p = 0.004), smoking (p = 0.024), fibrinolytic therapy (p = 0.012) and having 2 or 3 vessels CAD (p = 0.046). Cox proportional hazards regression model showed that patients with the DD genotype had a 1.5 increased risk of having an unfavorable outcome when compared with No-DD genotype patients (RR 1.561, 95% CI 1.048-2.326, p = 0.028) and that patients with the ACE DD genotype plus the AT1R No-AA genotype, the GPIIIa No-a1a1 genotype or a combination of both, had a twice higher risk than any other genotype of MACE in the follow-up (RR 1.978, 95% CI 1.286-3.043, p = 0.002).
Patients with the ACE DD genotype plus 1 or 2 unfavorable genotypes, the AT1R No-AA, the GPIIIa No-a1a1 or a combination of both, have twice higher the risk of MACE during their clinical follow-up.
冠状动脉疾病（CAD）已成为导致发病和死亡的常见原因，一些基因多态性与主要不良心脏事件（MACE）的复发有关。
对356例首次发生心肌梗死（MI）的患者进行了为期60个月的随访，以确定ACE I/D、AT1R A1166C、PAI-I 4G/5G和GPIIIa a1/a2基因多态性与其他经典心血管危险因素相结合是否会导致MACE复发。
首次心肌梗死后对285例（80.1%）男性和71例（19.9%）女性进行了随访。106例（29.8%）患者达到了主要临床终点，即MACE的复合终点。在Cox单因素生存分析中，影响预后较差的危险因素包括年龄（p = 0.004）、CAD家族史阳性（p = 0.007）、糖尿病（p = 0.004）、吸烟（p = 0.024）、溶栓治疗（p = 0.012）以及患有双支或三支血管病变的CAD（p = 0.046）。Cox比例风险回归模型显示，与非DD基因型患者相比，DD基因型患者出现不良结局的风险增加1.5倍（RR 1.561，95%CI 1.048 - 2.326，p = 0.028），并且携带ACE DD基因型加AT1R非AA基因型、GPIIIa非a1a1基因型或两者组合的患者在随访中发生MACE的风险比任何其他基因型高两倍（RR 1.978，95%CI 1.286 - 3.043，p = 0.002）。
携带ACE DD基因型加1种或2种不良基因型（AT1R非AA、GPIIIa非a1a1或两者组合）的患者在临床随访期间发生MACE的风险高两倍。
