Genetic associations of the origin and predictive estimation of the acute non-ST segment elevation myocardial infarction in patients with metabolic syndrome
Authors: Chumachenko N , Kosmacheva E.D 
Published: November 2020

Abstract

Background and introduction
Metabolic syndrome (MS) is a baseline condition that influencesthe management of patients with coronary heart disease (CHD). The assessment of genotyping characteristics in patients with MS with non-ST segment elevation myocardial infarction (nSTEMI) remains a challenge.

Purpose
To define characteristics of G Protein β3 subunit gene C825T polymorphism; T786C in the eNOS gene and G894T in the eNOS gene in patients with MS after nSTEMI, evaluate the prognostic specificity of genotypes in a study population.

Methods
The study included 150 patients with CHD and MS. The main group included 99 patients (69.7% males, a mean age of (67.4±0.7 y))with nSTEMI, preserved left ventricular systolic function who underwent urgent percutaneous coronary intervention. The control group included 51 patients with a mean age of (64.6±1.3 y) without the history of previous myocardial infarction and acute cerebrovascular disease. There was no statistically significant difference between gender and age in two groups (p&gt;0.05).
The predictive significance of the main group genotypes was estimated with odds ratio and risk ratio of “cumulative point of undesirable effects” (CPUE) and included: cardiovascular death, acute coronary syndrome, repeat revascularization, hospitalization for congestive heart failure. The accuracy of the genotype distribution corresponded to the Hardy-Weinberg equilibrium (p&gt;0.05). The accuracy of the results was analyzed using Student, χ2, Fisher's criteria.

Results
We received high patient numbers with CC genotype of eNOS:786 gene in the main group (n=19 (19.2%)) as compared with the controls (n=3 (6.2%)) (p&lt;0.05, φ=0.03), with GG genotype of eNOS:894 (p&lt;0.01, χ2=8.0) in the main group (n=59 (59.6%)) as compared with the controls (n=18 (35.3%)), with CC genotype of eNOS:894 in the control group (n=40 (78.4%)) as compared with the main group (n=56 (56.6%)) (p&lt;0.05; χ2=7.0). Patients who were heterozygous for eNOS:894 gene prevailed in the main group (n=30 (30.3%)) as compared with the controls (n=27 (52.9%)) (p&lt;0.01, χ2=7.3).
The statistically significant CPUE was more frequent diagnosed in patients with TT genotype of GNβ3:825 (OR=12.00, 95% confidence interval ((CI): 2.8–51.7, p&lt;0.05), CC genotype of eNOS:786 (OR=5.1, 95% CI: 1.3–20.0, p&lt;0.05) and TT genotype of eNOS:894 (OR=8.0, 95% CI: 1.8–35.2, p&lt;0,05).

Conclusions
4 practically applicable categories of reviewed genotypes were found: 1) nSTEMI - -protective: CC genotype for GNβ3:825 gene, GT – eNOS:894, 2) nSTEMI – unfavorable: CT–GNβ3:825, CC – eNOS:786 and GG – eNOS:894, 3) CPUE – unfavorable: TT – GNβ3:825, CC – eNOS:786, TT – eNOS:894, and 4) nSTEMI, CPUE-neutral: TT and TC – eNOs:786. CC – eNOS:786 genotype is separated as unfavorable for the development of both nSTEMI and CPUE. More studies are necessary for a personified approach, taken into account the obtained features of genetic associations.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Scientific Research Institute - S.V. Ochapovsky Clinic Regional Hospital #1, Krasnodar