Abstract
BackgroundThis 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).MethodsA 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.ResultsBased 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), p = 0.018], NACE [HR (95%CI):1.63 (1.23–2.16), p = 0.001], cardiovascular death [HR (95%CI):1.72 (1.01–2.92), p = 0.046], MACE [HR (95%CI):1.60 (1.19–2.16), p = 0.002], BARC class ≥ 3 [HR (95%CI):2.21 (1.16–4.22), p = 0.016], and BARC class ≥ 2 bleeding [HR (95%CI):1.91 (1.36–2.70), p < 0.001]. Subgroup analysis indicated consistent relationships between the big ET-1 ≥ 0.54 pmol/l and the primary endpoints.ConclusionElevated 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.
Highlights
Due to abundant common risk factors, the coexistence of coronary heart disease (CAD) and atrial fibrillation (AF) is prevalent, resulting in worse prognoses and increased healthcare burdens [1, 2]
Inclusion criteria included: [1] patients aged ≥18 years. [2] patients had paroxysmal, persistent, or permanent AF confirmed by clinical records and electrocardiographic evidence. [3] patients were diagnosed with acute coronary syndrome (ACS), or underwent percutaneous coronary intervention (PCI) during hospitalization
A total of 930 patients with AF and ACS or undergoing PCI were recruited from September 2016 to March 2020
Summary
Due to abundant common risk factors, the coexistence of coronary heart disease (CAD) and atrial fibrillation (AF) is prevalent, resulting in worse prognoses and increased healthcare burdens [1, 2]. It’s wellestablished that inflammation, endothelial dysfunction, atrial and ventricular remodeling play important roles in the occurrence and progression of CAD and AF. Several studies have demonstrated that elevated big ET-1 is a risk factor for adverse outcomes in patients with heart failure [12], CAD [13–16], AF [17], and hypertrophic cardiomyopathy [18]. The association between plasma big ET-1 levels and long-term outcomes in patients with AF and acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI) has not been evaluated before. 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)
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