Key result
In patients with coronary in-stent restenosis and diabetes, the highest tertile of plasma big endothelin-1 was associated with a significantly increased risk of major adverse cardiovascular events compared to the lowest tertile (HR 2.60).
Why the study?
Whether plasma big endothelin-1 is independently correlated with prognosis in patients with in-stent restenosis and diabetes undergoing PCI remained uncertain.
Does elevated baseline plasma big endothelin-1 predict major adverse cardiovascular events in patients with coronary in-stent restenosis and diabetes mellitus undergoing re-PCI?
Cohort (n=1,793)
No
Does elevated baseline plasma big endothelin-1 predict major adverse cardiovascular events in patients with coronary in-stent restenosis and diabetes mellitus undergoing re-PCI?
Hazard Ratio: 2.6 (95% CI 1.16–5.81)
p-value: p=0.02
Elevated plasma big endothelin-1 is an independent predictor of adverse cardiovascular events in patients with diabetes and coronary in-stent restenosis undergoing re-PCI, improving risk stratification beyond traditional factors.
May support big ET-1 for risk stratification in diabetic ISR after PCI; leaves open clinical utility pending validation.
Background Patients with diabetes are a high-risk group for coronary in-stent restenosis (ISR), so it would be valuable to identify biomarkers to predict their prognosis. The plasma big endothelin-1 (big ET-1) level is closely related to cardiovascular adverse events; however, for patients with ISR and diabetes who undergo percutaneous coronary intervention (PCI), whether big ET-1 is independently correlated with prognosis is still uncertain. Methods Patients with drug-eluting stent (DES) restenosis who underwent successful re-PCI from January 2017 to December 2018 at the Chinese Academy of Medical Sciences Fuwai Hospital were enrolled and followed up for 3 years. The patients were divided into the tertiles of baseline big ET-1. The primary end points were major adverse cardiovascular events (MACEs): cardiac death, non-fatal myocardial infarction (MI), target lesion revascularization (TLR), and stroke. A Cox multivariate proportional hazard model and the C-statistic were used to evaluate the potential predictive value of big ET-1 beyond traditional and angiographic risk factors. Results A total of 1,574 patients with ISR were included in this study, of whom 795 were diabetic. In patients with ISR and diabetes, after an average follow-up of 2.96 ± 0.56 years, with the first tertile of big ET-1 as a reference, the hazard ratio [HR] (95% CI) of MACEs after adjustment for traditional and angiographic risk factors was 1.24 (0.51–3.05) for the second tertile and 2.60 (1.16–5.81) for the third. Big ET-1 improved the predictive value for MACEs over traditional risk factors (C-statistic: 0.64 vs. 0.60, p = 0.03). Big ET-1 was not significantly associated with the risk of MACEs in patients without diabetes. Conclusion Increased plasma big ET-1 was associated with a higher risk of adverse cardiovascular prognosis independent of traditional and angiographic risk factors, and therefore, it might be used as a predictive biomarker, in patients with ISR and diabetes.
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Ma et al. (2022) conducted a cohort in Coronary in-stent restenosis and diabetes mellitus (n=1,793). Plasma big endothelin-1 (big ET-1) vs. First tertile of big ET-1 was evaluated on Major adverse cardiovascular events (MACEs) (HR 2.60, 95% CI 1.16-5.81, p=0.02). In patients with coronary in-stent restenosis and diabetes, the highest tertile of plasma big endothelin-1 was associated with a significantly increased risk of major adverse cardiovascular events compared to the lowest tertile (HR 2.60).
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