# The Role of Endothelin‐1, Kidney Function and Diabetes in Patients With Coronary Artery Disease Underwent Percutaneous Coronary Intervention

## TL;DR

This study shows that high levels of endothelin-1 in patients with heart disease and kidney issues or diabetes are linked to worse heart outcomes after a common heart procedure.

## Contribution

The study identifies a strong link between elevated endothelin-1 levels and increased risk of adverse outcomes in CAD patients with kidney dysfunction or diabetes after PCI.

## Key findings

- Elevated ET-1 levels in CAD patients with kidney dysfunction are associated with a 33% higher risk of MACE.
- CAD patients with diabetes, kidney dysfunction, and high ET-1 levels face a 2.297-fold increased MACE risk.
- ET-1 is a significant predictor of poor outcomes in CAD patients undergoing PCI, especially with comorbidities.

## Abstract

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 m2 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.

This study examined the relationship between ET‐1 and MACE in CAD patients with differing renal function and with or without diabetes undergoing PCI. CAD patients who have elevated ET‐1 levels, renal insufficiency (eGFR ≤ 60 mL/min/1.73 m2) and DM faced the greatest risk for MACE.