Estrogen Receptor-α Polymorphisms and Angiographic Outcome After Coronary Artery Stenting

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Abstract
Objective— Because of the receptor-mediated antiproliferative effects of estradiol on vascular smooth muscle cells, our study aimed at identifying a role of PvuII and XbaI polymorphisms of the α-estrogen receptor (αER) gene in the occurrence of restenosis after coronary stent implantation (in-stent restenosis [ISR]). Methods and Results— In 858 patients (148 women), 955 lesions were treated with stent implantation, and the PvuII C/T and XbaI G/A polymorphisms of the αER gene were determined. Quantitative angiography was performed before and after stenting and at 6-month follow-up. The allelic frequencies were similar between sexes (C/T allele, 0.43/0.57 and 0.44/0.56; P =0.9; G/A allele, 0.35/0.65 and 0.38/0.62; P =0.8; in women and men, respectively). A significantly higher ISR rate in women than in men homozygous for the T-allele of the PvuII polymorphism (42.6% versus 26.9%, P =0.03) or the G-allele of the XbaI polymorphism (41.2% versus 19.4%, P =0.04) was observed. At multivariate analysis, T/T genotype was the only independent predictor of ISR in women but not in men (odds ratio, 1.5; 95% CI, 1.0 to 2.1; P =0.03). XbaI polymorphism was no longer associated with ISR in both sexes. Conclusions— Women homozygous for the T-allele of the PvuII polymorphism of the αER gene treated with coronary stent implantation have a higher risk of ISR than men.