Key result
Elevated plasma big ET-1 levels (≥0.54 pmol/l) were independently associated with an increased risk of all-cause death (HR 1.73) and net adverse clinical events (HR 1.63) in patients with AF and ACS or undergoing PCI.
Why the study?
This study aimed to evaluate the association between plasma big ET-1 levels and long-term outcomes in patients with AF and ACS or undergoing PCI.
Does elevated plasma big endothelin-1 (≥0.54 pmol/l) predict increased risk of all-cause death and net adverse clinical events in patients with atrial fibrillation and acute coronary syndrome or undergoing percutaneous coronary intervention?
Cohort (n=930)
No
Does elevated plasma big endothelin-1 (≥0.54 pmol/l) predict increased risk of all-cause death and net adverse clinical events in patients with atrial fibrillation and acute coronary syndrome or undergoing percutaneous coronary intervention?
Effect estimate: HR 1.73 (95% CI 1.10-2.71)
Absolute Event Rate: 23.6% vs 5.8%
p-value: p=0.018
Elevated baseline plasma big ET-1 levels (≥0.54 pmol/l) independently predict increased risks of mortality, adverse cardiovascular events, and bleeding in patients with concurrent atrial fibrillation and acute coronary syndrome or undergoing PCI.
Background This study aimed to evaluate the association between plasma big ET-1 levels and long-term outcomes in patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI). Methods A total of 930 patients were enrolled and followed up for a median duration of 2.3 years. According to the optimal cutoff of big ET-1 for predicting all-cause death, these patients were divided into two groups. The primary endpoints were all-cause death and net adverse clinical events (NACE). The secondary endpoints included cardiovascular death, major adverse cardiovascular events (MACE), BARC class ≥ 3 bleeding, and BARC class ≥ 2 bleeding. Cox regressions were performed to evaluate the association between big ET-1 and outcomes. Results Based on the optimal cutoff of 0.54 pmol/l, 309 patients (33.2%) had high big ET-1 levels at baseline. Compared to the low big ET-1 group, patients in the high big ET-1 group tended to have more comorbidities, impaired cardiac function, elevated inflammatory levels, and worse prognosis. Univariable and multivariable Cox regressions indicated that big ET-1 ≥ 0.54 pmol/l was associated with increased incidences of all-cause death [HR (95%CI):1.73 (1.10–2.71), p = 0.018], NACE [HR (95%CI):1.63 (1.23–2.16), p = 0.001], cardiovascular death [HR (95%CI):1.72 (1.01–2.92), p = 0.046], MACE [HR (95%CI):1.60 (1.19–2.16), p = 0.002], BARC class ≥ 3 [HR (95%CI):2.21 (1.16–4.22), p = 0.016], and BARC class ≥ 2 bleeding [HR (95%CI):1.91 (1.36–2.70), p < 0.001]. Subgroup analysis indicated consistent relationships between the big ET-1 ≥ 0.54 pmol/l and the primary endpoints. Conclusion Elevated plasma big ET-1 levels were independently associated with increased risk of all-cause death, NACE, cardiovascular death, MACE, BARC class ≥ 3 bleeding, and BARC class ≥ 2 bleeding in patients with AF and ACS or undergoing PCI.
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Lyu et al. (2022) conducted a cohort in Atrial fibrillation and acute coronary syndrome or undergoing percutaneous coronary intervention (n=930). High plasma big ET-1 levels (≥0.54 pmol/l) vs. Low plasma big ET-1 levels (<0.54 pmol/l) was evaluated on All-cause death (HR 1.73, 95% CI 1.10-2.71, p=0.018). Elevated plasma big ET-1 levels (≥0.54 pmol/l) were independently associated with an increased risk of all-cause death (HR 1.73) and net adverse clinical events (HR 1.63) in patients with AF and ACS or undergoing PCI.
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