The Role of Endothelin-1, Kidney Function and Diabetes in Patients With Coronary Artery Disease Underwent Percutaneous Coronary Intervention.

OBJECTIVE

This study aimed to explore the association between plasma big endothelin-1 (ET-1) and major adverse cardiovascular events (MACE) in CAD patients who underwent PCI with a focus on the influence of kidney function and diabetes status in secondary prevention.

METHODS

A prospective cohort of CAD patients underwent PCI and patients with impaired kidney function and diabetes were initially screened and categorized separately, subdivided based on ET-1 levels. The primary outcome was MACE, including all-cause mortality, nonfatal myocardial infarction, unplanned revascularization, and stroke. Statistical analyses included Cox regression, competing risks analysis (competing for non-cardiovascular death), and restricted cubic spline to assess the relationships between ET-1 and MACE.

RESULTS

This study included 1344 CAD patients with impaired kidney function and 10,577 CAD patients with DM. During a median follow-up of 3 years, 20% of renal dysfunction patients and 12.9% of DM patients experienced MACE. In CAD patients with renal dysfunction, elevated ET-1 levels were associated with increased MACE risk (adjusted HR 1.333, 95% CI 1.169-1.519, p < 0.001), with those in the highest group and DM showing a 2.134-fold (95% CI, 1.334-3.413, p < 0.001) increased MACE risk. In CAD patients with DM, patients with eGFR ≤ 60 mL/min/1.73 m and elevated ET-1 levels had a 2.297-fold (95% CI 1.822-2.895) increased risk of MACE.

CONCLUSION

ET-1 offered important prognostic value for CAD patients who underwent PCI, with especially bad prognoses observed in those with elevated ET-1 levels, renal dysfunction, and DM.