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Prognostic Value of Plasma Big Endothelin-1 Level among Patients with Three-Vessel Disease: A Cohort Study
Ce Zhang1,2, Jian Tian2, Lin Jiang2
1State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College.
Insights
Plasma big endothelin-1 levels predict long-term mortality in patients with three-vessel disease (TVD). This biomarker improves risk prediction beyond the SYNTAX score II, aiding clinical decision-making.
Area of Science:
- Cardiovascular Medicine
- Biomarker Research
- Prognostic Studies
Background:
- Three-vessel disease (TVD) represents a significant atherosclerotic burden.
- Accurate prognostic markers are crucial for managing TVD patients.
- Endothelin-1 plays a role in vascular function and disease.
Purpose of the Study:
- To assess the prognostic value of plasma big endothelin-1 (big ET-1) in patients with TVD.
- To determine if big ET-1 improves mortality prediction beyond established scores.
- To investigate the association between big ET-1 levels and all-cause death in TVD.
Main Methods:
- Analysis of 6,150 TVD patients with available big ET-1 data.
- Division into high and low big ET-1 groups based on an optimal cutoff.
- Evaluation of all-cause death as the primary endpoint over a median follow-up of 6.8 years.
- Statistical analysis including multivariable models, C-index, NRI, and IDI.
Main Results:
- High plasma big ET-1 levels were significantly associated with increased all-cause mortality (HR: 1.36).
- Plasma big ET-1 was an independent predictor of mortality in TVD patients.
- Addition of big ET-1 significantly improved the predictive ability of the SYNTAX score II (P<0.001).
Conclusions:
- Plasma big endothelin-1 is a valuable independent predictor of long-term mortality in TVD.
- Big ET-1 enhances the prognostic discrimination and reclassification of the SYNTAX score II.
- Measuring plasma big ET-1 may refine risk stratification in TVD management.
Aim:
To evaluate the prognostic value of plasma big endothelin-1 level in the context of three-vessel disease (TVD) with heavy atherosclerotic burden.
Methods:
A total of 6,150 patients with TVD and available big endothelin-1 data were included in the study. Participants were divided into two groups according to the optimal cutoff value of big endothelin-1 for mortality prediction. The primary endpoint was all-cause death. C-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were calculated to evaluate the added prognostic value of plasma big endothelin-1 level beyond the SYNTAX score Ⅱ.
Results:
On the basis of the optimal cutoff value of 0.79 pmol/L, 1,984 patients were assigned to the high big endothelin-1 group. During a median follow-up of 6.8 years, 818 patients experienced all-cause death. Plasma big endothelin-1 level was significantly higher in patients who died than in patients who survived. Multivariable analysis found that high big endothelin-1 level was independently associated with an increased risk of mortality (hazard ratio: 1.36, 95% confidence interval: 1.18-1.57, P＜0.001). The association of big endothelin-1 with all-cause death was relatively consistent across subgroups with no significant interactions. The predictive ability of the SYNTAX score Ⅱ was significantly enhanced by addition of plasma big endothelin-1 level (C-index: 0.723 vs.0.715, P =0.029; NRI: 0.304, P＜0.001; IDI: 0.009, P＜0.001).
Conclusions:
Plasma big endothelin-1 level is an independent predictor of long-term mortality in patients with TVD. It can improve the discrimination and reclassification of the SYNTAX score Ⅱ for mortality prediction.
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