E-Science Station

Whether high plasma big endothelin-1 (ET-1) level confers an increased risk of long-term adverse outcomes after acute myocardial infarction (AMI) in the modern era of percutaneous coronary intervention (PCI) and medication remains uncertain. And some studies found only a moderate discrimination ability of the SYNTAX score for long-term mortality prediction in those patients. We sought to investigate the clinical impact of plasma big ET-1 level in AMI patients who underwent PCI, as well as the prognostic value of plasma big ET-1 beyond the SYNTAX score.

A total of 1,494 ”all-comer” patients in Fuwai hospital who underwent PCI for AMI were consecutively enrolled From January 2013 to December 2013. Patients were divided into two sub-groups based on an optimal cut-off value of plasma big ET-1 predicting 2-year all-cause mortality. Multivariable Cox regression analysis and receiver operating characteristic (ROC) curve analysis were conducted. Concordance index (C-index), continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were calculated to assess the added prognostic value of plasma big ET-1.

During 2-year follow-up, the high big ET-1 group was associated with a significantly higher rate of all-cause death (5.6% vs 0.5%, p < 0.001) and major adverse cardiovascular and cerebrovascular events (MACCE, 19.4% vs 12.6%, p = 0.003) compared to the low big ET-1 group. A big ET-1 cut-off value of 0.39 pmol/L had an area under curve of 0.846 (95% confidence interval [CI] 0.782 to 0.910),with 71.4% sensitivity and 82.8% specificity for the prediction of death. In multivariate analysis, high big ET-1 level was an independent predictor of 2-year all-cause mortality (hazard ratio [HR] 3.59, 95% CI 1.13 to 11.47, p =0.031), along with age, drug-eluting stent implantation and left main lesion. Addition of plasma big ET-1 to the SYNTAX score was associated with significant improvement in the C-index for prediction of all-cause death, and significant improvement in reclassification(NRI:21%, p = 0.015; IDI: 0.003, p = 0.018).

The admission plasma big ET-1 level was independently associated with 2-year mortality, which may aid in the risk stratification of patients undergoing PCI for AMI.