Angiotensin converting enzyme DD genotype is associated with acute coronary syndrome severity and sudden cardiac death in Taiwan: a case-control emergency room study

The ACE DD genotype was associated with ACS incidence. The DD genotype was associated with a significant 4-fold higher risk of ACS in multivariate analysis (odds ratio (OR) = 4.295; 95% confidence interval (CI): 1.436-12.851, p = 0.009), and a 3.35-fold higher risk of acute myocardial infarction. DD genotype carriers also had more than 3-fold higher risks of stenosis in all the three coronary arteries, left anterior descending artery infarction, and anterior wall infarction. In addition, the DD genotype was also associated with a higher risk of sudden cardiac death (OR = 6.484, 95% CI: 1.036-40.598, p = 0.046).This study demonstrated that the ACE DD genotype is an independent risk factor for ACS, and in particular, for acute myocardial infarction. In addition, the ACE DD genotype is also associated with greater ACS severity and a higher risk of sudden cardiac death. ACE genotyping is recommended for patients with a history of ACS, and more intensive preventive care is suggested for patients with the DD genotype.Acute coronary syndrome (ACS) is a common disease in the elderly, and a major determinant of morbidity and mortality in all races, ethnicities, and cultures [1]. The epidemic of coronary artery disease (CAD), especially its manifestation as ACS, is a global issue that accounts for more than 80% of the burden of this disease in developing countries [2], and results in approximately 30% of all deaths worldwide each year [3]. The spectrum of ACS disease severity ranges from unstable angina pectoris (UAP) to acute myocardial infarction (AMI), including ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). Sudden cardiac arrest is a major event of heart failure, and sudden cardiac death frequently presents as the first and only manifestation of previously unrecognized ischemic heart disease [4]. The prognosis of AMI-related heart failure depends on the extent and severity of ventricular dysfunction and morbidity [5]. Clinically, heart failure