ABSTRACT. Genetic and epigenetic factors interact in the pathophysiology of acute coronary syndromes. Recent studies have suggested correlations between mutations of the angiotensin-converting enzyme gene (ACE), the presence of D allele, and severe coronary lesions. We are presenting the case of a patient with unstable angina and several complications in the course of the percutaneous coronary intervention. A 64-year-old patient was admitted to our emergency institute, with preliminary observations of unstable angina. On admission, the patient was hemodynamically stable, had a chest pain and the electrocardiogram was positive for anterior ischemia. The echocardiography showed a moderate abnormal motion of the anterior wall. The coronarography revealed a critical stenosis (95%) of the proximal left anterior descendent. After the stent-implant, the injection of the contrast substance was followed by a leak of substance in the pericardium, which revealed a vessel rupture. We implanted a stent graft, with a good outcome. However, the patient was in shock. The echocardiography revealed pericardium liquid. Therefore, we tried a pericardium puncture, which could not be performed, so he was transferred to the department of Cardiovascular Surgery for a surgical drainage. We decided to determine whether the patient was positive for allele D mutation. Genetical analysis showed that the patient was heterozygote for the D allele. Genetic polymorphisms of the ACE-gene, associated with the standard risk factors, may contribute to the appearance of severe coronary lesions, with a higher impact on the patient’s status and intraprocedural evolution. pp. 173–181

Keywords: acute coronary syndrome; ACE-gene; D allele; coronary perforation; cardiac tamponade; revascularisation; complications