Eur J Vasc Endovasc Surg. 2002, 23(5): 421-425
Jones,K.; Powell,J.; Brown,L.; Greenhalgh,R.; Jormsjo,S.; Eriksson,Per
BACKGROUND: a single base pair deletion/insertion (4G/5G) polymorphism in the
plasminogen activator inhibitor (PAI-1) promoter appears to influence PAI-1 synthesis (increased PAI-1 and
inhibition of fibrinolysis with the 4G allele) and survival after severe trauma.
OBJECTIVE: to identify whether the 4G/5G polymorphism influences the natural
history of abdominal aortic aneurysm (AAA).
METHODS: Four hundred and sixty patients with small AAA were genotyped for the
4G/5G polymorphism. AAA growth was assessed from serial ultrasonographic measurements, subject to linear
regression analysis. Mortality following eventual elective surgery was recorded.
RESULTS: the frequency of the 3 genotypes (4G4G, 4G5G and 5G5G) was in
Hardy-Weinberg equilibrium and similar to that in a healthy population. The mean aneurysm growth rate was
0.37, 0.35 and 0.44 cm/year respectively for patients of 4G4G, 4G5G and 5G5G genotype respectively,
p = 0.07. The 30d mortality following open elective aneurysm repair was 8% (7/87), 8% (11/145) and 0%
(0/56) for patients of 4G4G, 4G5G and 5G5G genotype respectively, giving a higher mortality for those
carrying a 4G allele p = 0.03.
CONCLUSIONS: polymorphism of the PAI-1 gene promoter does not influence the
development of AAA, although AAA growth is faster for patients of 5G5G genotype. However, this genotype (
5G5G), which is associated with enhanced fibrinolysis, appears protective following open aneurysm repair.
This effect of PAI-1 genotype on survival following surgery is likely to have widespread significance
in vascular and general surgery.