Angiotensin converting enzyme DD genotype affects the changes of plasma plasminogen activator inhibitor-1 activity after primary percutaneous transluminal coronary angioplasty in acute myocardial infarction patients

Angiotensin converting enzyme (ACE) DD genotype, and plasminogen activator inhibitor (PAI-1) 4G/4G genotype have been reported to affect PAI-1 activit y in control subjects and atherosclerotic patients, but no data are availab le on the influence of angiotensin II type 1 receptor (AT1R) A1166C polymor phism on the inhibitor levels. The degree of fibrinolytic activation after percutaneous transluminal coronary angioplasty (PTCA) has been found to aff ect the risk of restenosis. The aim of this study was to investigate the po ssible influence of ACE I/D, AT1R A1166C, and PAI-1 4G/5G polymorphisms on the changes of PAI- 1 activity after primary successful percutaneous transl uminal angioplasty. In 29 consecutive acute myocardial infarction patients, undergoing primary successful angioplasty, genotyping of ACE I/D, AT1R A11 66C, and PAI-1 4G/5G polymorphisms was performed by polymerase chain reacti on and restriction fragment length polymorphism analysis, and PAI-1 plasma activity (chromogenic method) was assessed before and after angioplasty. Fo llowing angioplasty, PAI-1 activity increased in 10 of 29 patients and decr eased or remained unchanged in 19 of 29. ACE DD genotype was significantly (P = 0.04) associated with an increase of PAI-1 activity post angioplasty ( OR DD/ID+II = 6.5, CI 95% 4.83-8.22). Whereas no effect of PAI-1 4G/5G and AT1R A1166C polymorphisms on PAI-1 response to angioplasty was demonstrated , these data suggest that renin-angiotensin system genes are involved in th e regulation of the fibrinolytic response to balloon injury, possibly affec ting angiotensin converting enzyme activity. This interaction between the r enin-angiotensin system and hemostasis may be a mechanism by which ACE DD g enotype affects the risk of restenosis after percutaneous transluminal angi oplasty.