Genome-wide association study of perioperative myocardial infarction after coronary artery bypass surgery.
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OBJECTIVES: Identification of patient subpopulations susceptible to develop myocardial infarction (MI) or, conversely, those displaying either intrinsic cardioprotective phenotypes or highly responsive to protective interventions remain high-priority knowledge gaps. We sought to identify novel common genetic variants associated with perioperative MI in patients undergoing coronary artery bypass grafting using genome-wide association methodology. SETTING: 107 secondary and tertiary cardiac surgery centres across the USA. PARTICIPANTS: We conducted a stage I genome-wide association study (GWAS) in 1433 ethnically diverse patients of both genders (112 cases/1321 controls) from the Genetics of Myocardial Adverse Outcomes and Graft Failure (GeneMAGIC) study, and a stage II analysis in an expanded population of 2055 patients (225 cases/1830 controls) combined from the GeneMAGIC and Duke Perioperative Genetics and Safety Outcomes (PEGASUS) studies. Patients undergoing primary non-emergent coronary bypass grafting were included. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome variable was perioperative MI, defined as creatine kinase MB isoenzyme (CK-MB) values ≥10× upper limit of normal during the first postoperative day, and not attributable to preoperative MI. Secondary outcomes included postoperative CK-MB as a quantitative trait, or a dichotomised phenotype based on extreme quartiles of the CK-MB distribution. RESULTS: Following quality control and adjustment for clinical covariates, we identified 521 single nucleotide polymorphisms in the stage I GWAS analysis. Among these, 8 common variants in 3 genes or intergenic regions met p<10(-5) in stage II. A secondary analysis using CK-MB as a quantitative trait (minimum p=1.26×10(-3) for rs609418), or a dichotomised phenotype based on extreme CK-MB values (minimum p=7.72×10(-6) for rs4834703) supported these findings. Pathway analysis revealed that genes harbouring top-scoring variants cluster in pathways of biological relevance to extracellular matrix remodelling, endoplasmic reticulum-to-Golgi transport and inflammation. CONCLUSIONS: Using a two-stage GWAS and pathway analysis, we identified and prioritised several potential susceptibility loci for perioperative MI.
Coronary Artery Bypass
Genome-Wide Association Study
Published Version (Please cite this version)10.1136/bmjopen-2014-006920
Publication InfoAlexander, John Hunter Peel; Duke Perioperative Genetics and Safety Outcomes (PEGASUS) Investigative Team; Ji, Y; Joseph, D; Kertai, Miklos David; Li, YJ; ... Smith, PK (2015). Genome-wide association study of perioperative myocardial infarction after coronary artery bypass surgery. BMJ Open, 5(5). pp. e006920. 10.1136/bmjopen-2014-006920. Retrieved from https://hdl.handle.net/10161/11099.
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Professor of Medicine
John H. Alexander, MD, MHS is a cardiologist and Professor of Medicine in the Department of Medicine, Division of Cardiology at Duke University School of Medicine, as well as the Vice Chief, Clinical Research in the Division of Cardiology. He is the Director of Cardiovascular Research at the Duke Clinical Research Institute where he oversees a large group of clinical research faculty and a broad portfolio of cardiovascular clinical trials and observational clinical research programs. He is a
Associate Professor of Anesthesiology
Jerry Reves, M.D. Professor of Cardiac Anesthesiology
Current research interests include:1. The relationship between white matter patency, functional connectivity (fMRI) and neurocognitive function following cardiac surgery.2. The relationship between global and regional cortical beta-amyloid deposition and postoperative cognitive decline.3. The effect of lidocaine infusion upon neurocognitive function following cardiac surgery.4. The association between genotype and outcome after cardiac surgery.5. Atrial fibrillation
Professor Emeritus of Anesthesiology
Best known for his work in assessing and improving clinical outcomes and quality of life following cardiac surgery, Dr. Mark Newman is President of the Duke Private Diagnostic Clinic (The Duke Faculty Practice Organization) and the Merel H. Harmel Professor of Anesthesiology at Duke University Medical Center. In addition, Dr. Newman developed the Multicenter Perioperative Outcomes Research Group of the Duke Clinical Research Institute established at Duke in 2001 to further the study of strategie
Associate Professor of Anesthesiology
Basic-Translational: 1. Systems biology approaches to modeling perioperative cardiovascular injury and adaptation. 2. Mechanisms of perioperative myocardial injury; functional genomics applied to perioperative myocardial injury. 3. Metabolic consequences of perioperative myocardial ischemia-reperfusion injury. 4. Animal models and comparative genomic approaches to study perioperative myocardial ischemia-reperfusion injury. 5. Functional genomics of vein graft diseas
Alphabetical list of authors with Scholars@Duke profiles.