Prognostic Value of Plasma Big Endothelin-1 Level among Patients with Three-Vessel Disease: A Cohort Study

• Published in: Journal of Atherosclerosis and Thrombosis 2019/11/01, Vol.26(11), pp.959-969
• Main Authors: Zhang, Ce, Tian, Jian, Jiang, Lin, Xu, Lianjun, Liu, Junhao, Zhao, Xueyan, Feng, Xinxing, Wang, Dong, Zhang, Yin, Sun, Kai, Xu, Bo, Zhao, Wei, Hui, Rutai, Gao, Runlin, Yuan, Jinqing, Song, Lei
• Format: Article
• Language: English
• Subjects: Aged; Big endothelin-1; Biomarkers - blood; Case-Control Studies; Cause of Death; China - epidemiology; Coronary Artery Disease - blood; Coronary Artery Disease - epidemiology; Coronary Artery Disease - mortality; Endothelin-1 - blood; Female; Follow-Up Studies; Humans; Male; Middle Aged; Original; Prevalence; Prognosis; Prospective Studies; Survival Rate; Three-vessel coronary artery disease
• ISSN: 1340-3478; 1880-3873; 1880-3873
• DOI: 10.5551/jat.47324

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.