Background: Coronary artery ectasia (CAE) is found in about 1% of coronary angiography and is associated with poor clinical outcomes. The prognostic value of plasma big Endothelin-1 (ET-1) in CAE remains unknown.

Methods: Patients with angiographically confirmed CAE from 2009 to 2015, who had big ET-1 data available were included. The primary outcome was 5-year major adverse cardiovascular events (MACE), defined as a component of cardiovascular death and non-fatal myocardial infarction (MI). Patients were divided into high or low big ET-1 groups using a cut-off value of 0.58 pmol/L, according to the 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 the high big ET-1 group and 732 in the 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 non-fatal MI (6.09 vs. 2.84%; HR 2.17, 95% CI 1.11–4.24, P = 0.023). A higher risk of MACE in the high big ET-1 group was consistent in the propensity score matched cohort and propensity score weighted analysis. In multivariable analysis, a 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 high plasma big ET-1 concentrate and diffuse dilation, when used to predict 5-year MACE risk, yielded a 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, a finding that could improve risk stratification.

背景：冠状动脉扩张 (CAE) 出现在大约 1% 的冠状动脉造影中，并且与较差的临床结果相关。血浆大内皮素-1 (ET-1) 在 CAE 中的预后价值仍然未知。

方法：包括 2009 年至 2015 年经血管造影证实为 CAE 的患者，这些患者拥有大量可用的 ET-1 数据。主要结果是 5 年主要不良心血管事件 (MACE)，定义为心血管死亡和非致命性心肌梗死 (MI) 的一个组成部分。根据受试者工作特征曲线，使用 0.58 pmol/L 的截止值将患者分为高或低大 ET-1 组。采用Kaplan-Meier法、倾向评分法和Cox回归法评估2组的临床结局。

结果：共纳入992例患者，其中高大ET-1组260例，低大ET-1组732例。在 5 年的随访中，观察到 57 个 MACE。Kaplan-Meier 分析和单变量 Cox 回归表明，大 ET-1 水平高的患者发生 MACE 的风险增加（9.87 对 4.50%；HR 2.23，95% CI 1.32-3.78，磷 = 0.003)，心血管死亡（4.01 对 1.69%；HR 2.37，95% CI 1.02–5.48， 磷 = 0.044) 和非致命 MI（6.09 对 2.84%；HR 2.17，95% CI 1.11–4.24， 磷= 0.023）。在倾向评分匹配队列和倾向评分加权分析中，高大 ET-1 组的 MACE 风险较高。在多变量分析中，高血浆大 ET-1 水平仍然是 MACE 的独立预测因子（HR 1.82，95% CI 1.02–3.25，磷= 0.043）。当用于预测 5 年 MACE 风险时，高血浆大 ET-1 浓缩物和弥漫性扩张的组合产生 0.67（95% CI 0.59–0.74）的 C 统计量。

结论： 在 CAE 患者中，高血浆大 ET-1 水平与 MACE 风险增加相关，这一发现可以改善风险分层。