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Plasma endothelin determination as a prognostic indicator of 1-year mortality after acute myocardial infarction
Insights
Elevated plasma endothelin levels measured 3 days after myocardial infarction strongly predict 1-year mortality. This finding offers crucial prognostic information for heart attack patients, independent of other known risk factors.
Area of Science:
- Cardiology
- Biochemistry
Background:
- Plasma endothelin levels rise in acute myocardial infarction and chronic heart failure.
- Endothelin's vasoconstrictive and cardiotoxic effects suggest a link to poor prognosis post-myocardial infarction.
Purpose of the Study:
- To investigate the prognostic value of plasma endothelin levels in the subacute phase of myocardial infarction.
- To determine if endothelin measurements offer additional prognostic insight beyond established clinical and biochemical markers.
Main Methods:
- Plasma endothelin was measured on day 3 in 142 myocardial infarction patients.
- One-year mortality was tracked.
- Cox proportional-hazards models were used for analysis.
Main Results:
- Day 3 plasma endothelin concentrations significantly predicted 1-year mortality (P < .0001).
- Endothelin levels provided prognostic information independent of age, hypertension history, heart failure presence, and plasma atrial natriuretic factor.
Conclusions:
- Plasma endothelin concentrations are a strong predictor of outcomes following myocardial infarction.
- Endothelin measurements offer independent prognostic value, enhancing risk stratification for heart attack survivors.
Background:
Plasma endothelin concentrations are increased in the acute phase of myocardial infarction and in chronic heart failure. Since endothelin may contribute to hemodynamic deterioration by potent vasoconstrictory and cardiotoxic actions, increased plasma levels may be associated with an unfavorable prognosis after myocardial infarction.
Methods And Results:
We tested the hypothesis that plasma endothelin determination in the subacute phase of myocardial infarction is related to subsequent survival and assessed whether plasma endothelin measurements provide additional prognostic information to that obtained from clinical and biochemical variables previously known to be associated with high mortality. Plasma endothelin determination was obtained from 142 patients (average age +/- SD, 67.8 +/- 10.1 years) on day 3 after documented myocardial infarction and was related to 1-year mortality. Sixteen patients died during the follow-up period. In a univariate Cox proportional-hazards model, day 3 plasma endothelin concentrations were significantly related to mortality (P < .0001). Patient age, previous treatment for systemic hypertension, presence of clinical heart failure, and plasma atrial natriuretic factor levels were all related to mortality in univariate analysis but provided no additional prognostic information to that obtained from endothelin determination in a multivariate model.
Conclusions:
Plasma endothelin concentrations are strongly related to outcome after myocardial infarction and provide prognostic information independent of clinical and biochemical variables previously associated with a poor prognosis.