The antiplatelet therapeutical strategies in dependance on the VEGF-A gene G634C polymorphism in patients with acute myocardial infarction with ST segment elevation after successful PCI

Abstract

The aim of the study was to evaluate the associations between the polymorphism G634C (rs 2010963) of the VEGF-A gene and the level of STEMI biomarkers with double antiplatelet therapy. Materials and methods. 135 patients were enrolled in the case-control study, including 109 (80.7%) men and 26 (19.3%) women, the average age was 59.21 ± 8.92 years. The control group consisted of 30 healthy individuals. Primary percutaneous coronary intervention (PCI) using bare-metal coronary stent (BMS) was performed in 109 patients, 31 patients underwent systemic thrombolysis. The coronary blood flow was restored at the TIMI ІІІ level. Ultrasound examination of the heart was carried out on 3-5 days of hospitalization and after 6 months of observation. The study of the G634C allelic polymorphism (rs 2010963) of the VEGF-A gene was carried out by the method of polymerase chain reaction (PCR) in real time using the Syntol reagent kit (Russia). The level of VEGF-A was determined on the first day of the disease and after 6 months by enzyme immunoassay using reagents IBLINTERNATIONAL, GMBH, (Germany). Patients were divided into two groups: the first one was “case” group - patients who reached the end point, and the second group was “control” - did not reached. The combined endpoint was defined as: cardiovascular death, recurrent myocardial infarction, the occurrence / progression of heart failure that required hospitalization. Results. The left ventricular ejection fraction (p = 0.002) and creatinine clearance (p = 0.018) were significantly lower in the case group, the diastolic dysfunction E/E 'was higher in the control group (p = 0.007). The level of VEGF-A is significantly lower in the “case” group, in this group there was a higher frequency of the 634GC + 634CC polymorphism of the VEGF-A gene (p = 0.035). The frequency of treatment with clopidogrel was higher in the case group (p = 0.031), and ticagrelor was more often prescribed in the control group (p = 0.031). Logistic uni-and multivariate analysis showed that independent predictors of adverse events after STEMI were polymorphism 634GC + 634CC of the VEGF-A gene, ejection fraction <50.60% and the clopidogrel antiplatelet therapy in the group of the polymorphic variant of the VEGF-A gene. Conclusions: The presence of the 634GC + 634CC polymorphism of the VEGF-A gene, ejection fraction <50.60% and the clopidogrel treatment are independent predictors of adverse events in STEMI patients. The administration of ticagrelor against clopidogrel significantly benefit the course of the post-infarction period in patients with STEMI after successful PCI.

Keywords

• acute myocardial infarction with st segment elevation, g634c polymorphism (rs 2010963) vegf-a gene, ticagrelor, clopidogrel.