Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
Institute of Internal Medicine, Catholic University of the Sacred Heart, Rome, Italy.
Eur Heart J Acute Cardiovasc Care. 2019 Dec;8(8):703-707. doi: 10.1177/2048872617735808. Epub 2017 Oct 6.
Microvascular obstruction (MVO) after primary percutaneous coronary intervention (pPCI) leads to higher incidence of both early and late complications. A number of single nucleotide polymorphisms in 9p21 chromosome have been shown to affect angiogenesis in response to ischaemia. In particular, Rs1333040 with its three genotypic vriants C/C, T/C and T/T might influence the occurrence of MVO after pPCI.
We enrolled ST-elevation myocardial infarction (STEMI) patients undergoing pPCI. The Rs1333040 polymorphism was evaluated by polymerase chain reaction-restriction fragment length polymorphism using restriction endonucleases (Bsml). Two expert operators unaware of the patients' identity performed the angiographic analysis; collaterals were assessed applying Rentrop's classification. Angiographic MVO was defined as a post-pPCI Thrombolysis In Myocardial Infarction (TIMI)<3 or TIMI 3 with myocardial blush grade 0 or 1, whereas electrocardiographic MVO was defined as ST segment resolution <70% one hour after pPCI.
Among our 133 STEMI patients (mean age 63 ± 11 years, men 72%), 35 (26%) and 53 (40%) respectively experienced angiographic or electrocardiographic MVO. Angiographic and electrocardiographic MVO were different among the three variants (= 0.03 and =0.02 respectively). In particular, T/T genotype was associated with a higher incidence of both angiographic and electrocardiographic MVO compared with C/C genotype (=0.04 and =0.03 respectively). Moreover, Rentrop score <2 detection rate differed among the three genotypes (=0.03). In particular T/T genotype was associated with a higher incidence of a Rentrop score <2 as compared with C/C genotype (= 0.02).
Rs1333040 polymorphism genetic variants portend different MVO incidence. In particular, T/T genotype is related to angiographic and electrocardiographic MVO and to worse collaterals towards the culprit artery.
原发性经皮冠状动脉介入治疗（pPCI）后的微血管阻塞（MVO）会导致早期和晚期并发症的发生率更高。9p21 染色体上的许多单核苷酸多态性已被证明会影响缺血后的血管生成。特别是，Rs1333040 及其三种基因型变体 C/C、T/C 和 T/T 可能会影响 pPCI 后的 MVO 发生。
我们纳入了接受 pPCI 的 ST 段抬高型心肌梗死（STEMI）患者。通过聚合酶链反应-限制性片段长度多态性，使用限制内切酶（Bsml）评估 Rs1333040 多态性。两名不了解患者身份的专家操作员进行了血管造影分析；侧支循环采用 Rentrop 分类进行评估。血管造影 MVO 定义为 pPCI 后 Thrombolysis In Myocardial Infarction（TIMI）<3 或 TIMI 3 伴心肌灌注分级 0 或 1，而心电图 MVO 定义为 pPCI 后 1 小时 ST 段缓解<70%。
在我们的 133 名 STEMI 患者中（平均年龄 63±11 岁，男性 72%），分别有 35 名（26%）和 53 名（40%）发生了血管造影或心电图 MVO。三种变体之间的血管造影和心电图 MVO 存在差异（=0.03 和=0.02）。特别是，T/T 基因型与血管造影和心电图 MVO 的发生率均高于 C/C 基因型（=0.04 和=0.03）。此外，三种基因型之间的 Rentrop 评分<2 的检出率存在差异（=0.03）。特别是 T/T 基因型与 C/C 基因型相比，Rentrop 评分<2 的发生率更高（=0.02）。
Rs1333040 多态性遗传变体预示着不同的 MVO 发生率。特别是，T/T 基因型与血管造影和心电图 MVO 以及罪犯动脉侧支循环较差有关。
