doi: 10.1161/CIRCULATIONAHA.106.679530
(Circulation. 2007;116:I-106 – I-112.)
© 2007 American Heart Association, Inc.
Myocardial Protection, Perioperative Management, and Vascular Biology |
The MBL2 ‘LYQA Secretor’ Haplotype Is an Independent Predictor of Postoperative Myocardial Infarction in Whites Undergoing Coronary Artery Bypass Graft Surgery
From the Baylor College of Medicine (C.D.C.), Division of Cardiovascular Anesthesiology at the Texas Heart Institute, St. Luke’s Episcopal Hospital, Houston, Texas; the Department of Anesthesiology, Perioperative and Pain Medicine (S.K.S., A.A.F., S.C.B.), Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass; the Center for Cancer Research (T.B., S.J.C.), National Cancer Institute, Bethesda, Md; the Division of Biostatistics and Epidemiology (W.K.V.), Texas Heart Institute, St Luke’s Episcopal Hospital, Houston, Texas; the Laboratory of Developmental Immunology, Department of Pediatrics (K.T.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Merck Research Laboratories (A.B.E.), Rahway, NJ; and the Department of Pathology (P.J.), Brigham & Women’s Hospital, Harvard Medical School, Boston, Mass.
Correspondence to Charles D. Collard, MD, Professor, Baylor College of Medicine, Texas Heart Institute, St Luke’s Episcopal Hospital, 6720 Bertner Avenue, Houston, TX 77030. E-mail ccollard{at}heart.thi.tmc.edu
Background— Mannose-binding lectin (MBL) is an important component of innate immunity and activator of the lectin complement pathway. Within the MBL2 gene are seven 5' "secretor" haplotypes that code for altered serum MBL levels and complement activation. However, recent evidence suggests that 3' MBL2 haplotypes may also modify MBL function and circulating levels. Because MBL and the lectin complement pathway have been implicated in cardiovascular injury, we investigated whether MBL2 haplotypes are independently associated with an increased risk of postoperative myocardial infarction (PMI) in patients undergoing coronary artery bypass graft surgery.
Methods and Results— Genotyping of 18 polymorphic sites within the MBL2 gene was performed in a prospective, longitudinal multi-institutional study of 978 patients undergoing primary coronary artery bypass graft-only surgery with cardiopulmonary bypass between August 2001 and May 2005. After adjustment for multiple comparisons by permutation testing, multivariate, stepwise logistic regression, including a score test, was performed controlling for patient demographics, preoperative risk factors, medications, and intraoperative variables to determine if MBL2 secretor haplotypes are independent predictors of PMI in whites undergoing primary coronary artery bypass graft surgery. Neither the 5' nor 3' MBL2 haplotypes alone were associated with an increased incidence of PMI. However, the incidence of PMI in whites (n=843) expressing the combined MBL2 5' LYQA secretor haplotype (CGTCGG) and 3' haplotype (CGGGT) was significantly higher than in whites not expressing the haplotype (38% versus 10%; P<0.007). Moreover, the combined MBL2 LYQA secretor haplotype was an independent predictor of PMI in whites after primary coronary artery bypass graft surgery after adjustment for other covariates (P<0.02; adjusted OR: 3.97; 95% CI: 1.30 to 12.07). The combined MBL2 LYQA secretor haplotype in whites was also an independent predictor of postoperative CKMB levels exceeding 60 ng/mL (P<0.02; adjusted OR: 4.48; 95% CI: 1.95 to 16.80). Inclusion of the combined MBL2 LYQA secretor haplotype improved prediction models for PMI based on traditional risk factors alone (C-statistic 0.715 versus 0.705).
Conclusions— The combined MBL2 LYQA secretor haplotype is a novel independent predictor of PMI and may aid in preoperative risk stratification of whites undergoing primary coronary artery bypass graft surgery.
Key Words: genetics • myocardial infarction • immunology • inflammation • surgery