Ye Zixiang, Xie Enmin, Du Yuan, Zhang Wenjia, Dou Kefei
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
State Key Laboratory of Cardiovascular Disease, Beijing, China.
J Diabetes. 2025 Jul;17(7):e70127. doi: 10.1111/1753-0407.70127.
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.
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.
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.
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.
本研究旨在探讨接受经皮冠状动脉介入治疗（PCI）的冠心病（CAD）患者血浆大内皮素-1（ET-1）与主要不良心血管事件（MACE）之间的关联，重点关注肾功能和糖尿病状态在二级预防中的影响。
对接受PCI的CAD患者进行前瞻性队列研究，最初对肾功能受损和糖尿病患者进行单独筛查和分类，然后根据ET-1水平进一步细分。主要结局是MACE，包括全因死亡率、非致命性心肌梗死、非计划性血管重建和中风。统计分析包括Cox回归、竞争风险分析（竞争非心血管死亡）和受限立方样条图，以评估ET-1与MACE之间的关系。
本研究纳入了1344例肾功能受损的CAD患者和10577例糖尿病CAD患者。在中位随访3年期间，20%的肾功能不全患者和12.9%的糖尿病患者发生了MACE。在肾功能不全的CAD患者中，ET-1水平升高与MACE风险增加相关（调整后HR 1.333，95%CI 1.169-1.519，p<0.001），最高组和糖尿病患者的MACE风险增加2.134倍（95%CI，1.334-3.413，p<0.001）。在糖尿病CAD患者中，估算肾小球滤过率（eGFR）≤60 mL/min/1.73 m²且ET-1水平升高的患者发生MACE的风险增加2.297倍（95%CI 1.822-2.895）。
ET-1对接受PCI的CAD患者具有重要的预后价值，ET-1水平升高、肾功能不全和糖尿病患者的预后尤其不良。
