AUTHOR=Cai Zhongxing , Wang Haoyu , Yuan Sheng , Yin Dong , Song Weihua , Dou Kefei 

TITLE=Plasma Big Endothelin-1 Level Predicted 5-Year Major Adverse Cardiovascular Events in Patients With Coronary Artery Ectasia

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.768431

DOI=10.3389/fcvm.2021.768431

ISSN=2297-055X

ABSTRACT=Background: Coronary artery ectasia (CAE) was found in about 1% of coronary angiography and associated with poor clinical outcomes. The prognostic value of plasma big Endothelin-1 (ET-1) in CAE remained unknown. 
Methods: Patients with angiographically confirmed CAE during 2009 to 2015 and who had big ET-1 data available were included. The primary outcome was 5-year major adverse cardiovascular event (MACE), which was a component of cardiovascular death and nonfatal myocardial infarction (MI). Patients were divided into high or low big ET-1 group using a cut-off value of 0.58pmol/L, according to receiver operating characteristic curve. Kaplan-Meier method, propensity score method and Cox regression were used to assess the clinical outcomes in the 2 groups.
Results: A total of 992 patients were included, with 260 in high big ET-1 group and 732 in low big ET-1 group. At 5-year follow-up, 57 MACEs were observed. Kaplan-Meier analysis and univariable Cox regression showed that patients with high big ET-1 levels were at increased risk of MACE (9.87% vs. 4.50%; HR 2.23, 95% CI 1.32-3.78, P=0.003), cardiovascular death (4.01% vs. 1.69%; HR 2.37, 95% CI 1.02-5.48, P=0.044) and nonfatal MI (6.09% vs. 2.84%; HR 2.17, 95% CI 1.11-4.24, P=0.023). Higher risk of MACE in high big ET-1 group was consistent in propensity score matched cohort and propensity score weighted analysis. In multivariable analysis, high plasma big ET-1 level was still an independent predictor of MACE (HR 1.82, 95% CI 1.02-3.25, P=0.043). A combination of plasma big ET-1 concentrate and diffuse dilation to predict 5-year MACE risk yielded C-statistic of 0.67 (95% CI 0.59-0.74).
Conclusion: Among patients with CAE, high plasma big ET-1 level was associated with increased risk of MACE and it was useful to improve risk stratification.