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Pascalle S. Monraats, Jamal S. Rana, Aeilko H. Zwinderman, Moniek P. M. de Maat, John P. Kastelein, Willem R. P. Agema, Pieter A. F. Doevendans, Robbert J. de Winter, Ren A. Tio, Johannes Waltenberger, Rune R. Frants, Arnoud van der Laarse, Ernst E. van d
455 G/A polymorphism and preprocedural plasma levels of fibrinogen show no association with the risk of clinical restenosis in patients with coronary stent placement
The effect of preprocedural fibrinogen levels on in-stent restenosis is largely unknown. The 455 G/A polymorphism of the fibrinogen -gene is associated with baseline plasma level or acute phase increase of fibrinogen. Therefore, we hypothesized that there is a relationship between this polymorphism and preprocedural fibrinogen level and clinical restenosis at follow-up among patients with coronary stent placement. The GENetic DEterminants of Restenosis (GENDER) project is a multicenter follow-up study that enrolled 3,146 consecutive patients after successful percutaneous coronary intervention. A coronary stent was placed in 2,309 patients. Of these, 2,257 (97.7%) patients were successfully genotyped for the 455G/A polymorphism. Plasma fibrinogen levels were measured at baseline in a subpopulation of 623 stented patients with the von Clauss method and patients were grouped into tertiles according to fibrinogen levels. Primary endpoint was target vessel revascularization (TVR); secondary combined endpoint was defined as death presumably from cardiac causes, MI not attributable to another coronary artery than the target vessel, and TVR. No association was observed between the 455G/A polymorphism and TVR or combined endpoint (p=0.99, p=0.97, respectively). Multivariate regression analysis revealed that the risk of TVR and combined endpoint was not higher for patients in the highest tertile for fibrinogen versus the lowest tertile (RR=0.60,95% CI: 0.261.37 for TVR, RR=0.64, 95% CI: 0.291.44 for combined endpoint). In conclusion, the presence of 455G/A polymorphism in the fibrinogen -gene and preprocedural fibrinogen level is not associated with an increased risk of TVR or combined endpoint in a patient population with coronary stent placement. Therefore, these parameters are not worthwhile for stratifying patients at risk for restenosis pre-stenting.
Thrombosis and Haemostasis, Schattauer
Print ISSN: 0340-6245
Volume: 93, 03/2005
Pages: 564 - 569