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Pathophysiology/Complications
OBJECTIVE - 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.
RESEARCH DESIGN AND METHODS - 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.
RESULTS - 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.
CONCLUSIONS - 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.
Abbreviations: CABG, coronary artery bypass grafting; CVD, cardiovascular disease; Hp, haptoglobin; MACE, major adverse cardiac event; MI, myocardial infarction; PTCA, percutaneous transluminal coronary angioplasty; TVR, target vessel revasculation.
A table elsewhere in this issue shows conventional and Systeme International (SI) units and conversion factors for many substances.
Patients with diabetes have a three- to fivefold increase in risk of atherosclerotic cardiovascular disease (CVD) compared with nondiabetic individuals (1,2). Diabetes is also recognized as a risk factor for poor outcome after percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG) (3-10). The Bypass Angioplasty Revascularization Investigation (BARI) directly compared PTCA and CABG in patients with multivessel disease and demonstrated a clear advantage of CABG over PTCA in patients with treated diabetes (9,10). Accordingly, CABG is currently recommended over multivessel PTCA in all diabetic patients with multivessel coronary artery disease.
The haptoglobin (Hp) gene...