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Introduction: Progression of coronary artery disease after primary coronary artery bypass grafting (CABG) is frequent and leads to recurrent angina, myocardial infarction, and the need for re-interventions. We hypothesized that classical risk factors of atherosclerosis as well as genetic disposition may be associated with progression of coronary artery disease leading to re-interventions.
Patients and Methods: We investigated 100 patients (18 % female) who had primary and secondary CABG surgery at our institution within 10 years (progressive atherosclerosis group: PA) and compared them with a group of 100 patients without the need of re-operation within 10 years (stable atherosclerosis group: SA). Polymorphisms of genes encoding for coagulation factors (platelet activator inhibitor-I, prothrombin, factor V), eNOS, and apoprotein E were determined.
Results: Distribution of classical risk factors of atherosclerosis (diabetes, smoking history, hypertension, hyperlipidemia) did not discriminate among SA and PA patients. However, patients with wild type eNOS 4ab expression were 20 % more likely to undergo reoperation (p=0.04). Homozygous patients for the PAI 1 [4G-668/5G] mutation had less recurrent symptoms (p=0.05) and had less re-interventions (p=0.045). All patients (n=11; 100%) with the rare allel combination 24, 44 and 22 of apoprotein E had recurrent symptoms (p=0.019) and were more likely to undergo PTCA (p=0.01) postoperatively. Likewise all patients with a prothrombin mutation (n=3; 100%) needed reoperation (p=0.1).
Conclusion: Polymorphisms of genes encoding eNOS, apoprotein E, prothrombin, and PAI-1 are associated with an increased risk of re-operation and re-intervention after primary CABG surgery. Genotyping provides important information, because classical risk factors of atherosclerosis fail in the assessment of the reoperation risk.

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