Insertion/deletion polymorphism of the angiotensin I-converting enzyme gene is not associated with restenosis after coronary stent placement

Background-The renin-angiotensin system is thought to play a role in corona ry thrombosis and restenosis. Plasma angiotensin I-converting enzyme (ACE) activity is associated with an insertion/deletion polymorphism in the gene coding for ACE. The objective of this study was to test the hypothesis that the D allele of the ACE gene is associated with a higher risk for restenos is after coronary stent placement. Methods and Results-This prospective study included 1850 consecutive patien ts with coronary artery disease who underwent intracoronary stent implantat ion. The adverse clinical events recorded were death, myocardial infarction , and target vessel revascularization. The primary end point of the study w as restenosis (greater than or equal to 50% diameter stenosis at follow-up angiography performed in 84% of the patients). The secondary end point was clinical outcome 1 year after the procedure. The restenosis rate at the 6-m onth angiographic follow-up was 32.8% in patients with the II genotype, 34. 0% for patients with the ID genotype, and 31.2% for patients with the DD ge notype (P=0.62). One-year event-free survival was 77.7% in patients with ge notype II, 75.2% in patients with genotype ID, and 75.5% in patients with g enotype DD (P=0.54). The lack of association was also present in the subgro up of patients with a low risk for restenosis: the restenosis rate was 21.7 % in II carriers, 23.4% in ID carriers, acid 19.7% in DD carriers (P=0.83). Conclusions-The ACE DD genotype or D allele does not influence the 1-year c linical and angiographic outcome of patients undergoing coronary stent plac ement. These data suggest that routine determination of the ACE genotype ma y not help identify patients who are at a higher risk of thrombotic and res tenotic events after coronary stent placement.