心房颤动合并急性冠状动脉综合征或接受经皮冠状动脉介入治疗患者的血浆大内皮素-1水平与长期预后
Plasma Big Endothelin-1 Levels and Long-Term Outcomes in Patients With Atrial Fibrillation and Acute Coronary Syndrome or Undergoing Percutaneous Coronary Intervention.
作者信息
Lyu Si-Qi, Zhu Jun, Wang Juan, Wu Shuang, Zhang Han, Shao Xing-Hui, Yang Yan-Min
机构信息
Emergency and Critical Care Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
出版信息
Front Cardiovasc Med. 2022 Mar 3;9:756082. doi: 10.3389/fcvm.2022.756082. eCollection 2022.
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), = 0.018], NACE [HR (95%CI):1.63 (1.23-2.16), = 0.001], cardiovascular death [HR (95%CI):1.72 (1.01-2.92), = 0.046], MACE [HR (95%CI):1.60 (1.19-2.16), = 0.002], BARC class ≥ 3 [HR (95%CI):2.21 (1.16-4.22), = 0.016], and BARC class ≥ 2 bleeding [HR (95%CI):1.91 (1.36-2.70), < 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.
背景
本研究旨在评估血浆大内皮素-1（big ET-1）水平与心房颤动（AF）合并急性冠状动脉综合征（ACS）患者或接受经皮冠状动脉介入治疗（PCI）患者的长期预后之间的关联。
方法
共纳入930例患者，中位随访时间为2.3年。根据big ET-1预测全因死亡的最佳截断值，将这些患者分为两组。主要终点为全因死亡和净不良临床事件（NACE）。次要终点包括心血管死亡、主要不良心血管事件（MACE）、BARC 3级及以上出血和BARC 2级及以上出血。采用Cox回归评估big ET-1与预后之间的关联。
结果
基于0.54 pmol/l的最佳截断值，309例患者（33.2%）基线时big ET-1水平较高。与低big ET-1组相比，高big ET-1组患者往往合并症更多、心功能受损、炎症水平升高且预后更差。单变量和多变量Cox回归表明，big ET-1≥0.54 pmol/l与全因死亡[风险比（95%置信区间）：1.73（1.10 - 2.71），P = 0.018]、NACE[风险比（95%置信区间）：1.63（1.23 - 2.16），P = 0.001]、心血管死亡[风险比（95%置信区间）：1.72（1.01 - 2.92），P = 0.046]、MACE[风险比（95%置信区间）：1.60（1.19 - 2.16），P = 0.002]、BARC 3级及以上[风险比（95%置信区间）：2.21（1.16 - 4.22），P = 0.016]和BARC 2级及以上出血[风险比（95%置信区间）：1.91（1.36 - 2.70），P < 0.001]的发生率增加相关。亚组分析表明，big ET-1≥0.54 pmol/l与主要终点之间存在一致的关系。
结论
血浆big ET-1水平升高与AF合并ACS患者或接受PCI患者的全因死亡、NACE、心血管死亡、MACE、BARC 3级及以上出血和BARC 2级及以上出血风险增加独立相关。
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