| Objective:Big endothelin-1(big ET-1)is associated with the prognosis of various cardiovascular diseases.This study is to explore the predictive value of plasma big ET-1 level for long-term outcome after coronary artery bypass grafting and mitral valvuloplasty in patients with moderate to severe chronic ischemic mitral insufficiency.Methods:A total of 142 consecutive patients with moderate to severe chronic ischemic mitral regurgitation who underwent coronary artery bypass grafting and mitral valvuloplasty were enrolled at our center from January 2009 to December 2015.The clinical baseline data were collected and recorded.All patients were followed up.The mortalities and major adverse cardiovascular and cerebrovascular events during the follow-up period were recorded.Results:A total of 142 patients were enrolled,with an average age of 59.4±8.3 years.During 51.9±22.6 months follow-up,19 cases(13.4%)died and 35 cases(24.6%)had major adverse cardiovascular and cerebrovascular events.Univariate and multivariatee Cox regression analysis showed that big ET-1 was an independent risk factor for all-cause mortality(HR 3.970,95%Cl 1.535-10.268)and major adverse cardiovascular and cerebrovascular events(HR 2.754,95%CI 1.238-6.129).In addition,left ventricular ejection fraction,pulmonary hypertension and stroke history were independent risk factors for all-cause mortality,while left ventricular ejection fraction,stroke history were independent risk factors for major adverse cardiovascular and cerebrovascular events.Conclusion:Long-term outcomes of simultaneous coronary artery bypass grafting and mitral valvuloplasty for moderate to severe ischemic mitral insufficiency are satisfactory and big ET-1 is an independent risk factor for long-term outcomes of these patients.Background:Elevated plasma levels of endothelin-1(ET-1)have been proposed as a novel prognostic indicator in patients with concomitant coronary artery disease and chronic kidney disease(CKD).However,there is a paucity data on the prognostic impact of ET-1 on the outcomes of CKD patients undergoing coronary artery bypass grafting.Objective:The objective of this study was to assess the prognostic value of big ET-1 on the long-term survival in patients with concomitant coronary artery disease and CKD.Methods:A total of 144 consecutive CKD patients who underwent coronary artery bypass grafting were enrolled at our center between January 2010 and December 2010.The clinical baseline data were collected and recorded.All patients were followed up.The mortality and major adverse cardiovascular and cerebrovascular events were recorded during the follow-up period.Results:The mean age of patients was 63.2±9.9 years.During 4.3 ± 0.9 years of follow-up,14(9.7%)patients died,of whom 8(5.5%)died of cardiovascular causes.The correlation analysis showed that ET-1 level was positively correlated with body mass index,creatinine,brain natriuretic peptide,negatively correlated with left ventricular ejection fraction,estimated glomerular filtration rate and high density lipoprotein.Multivariate Cox proportional hazard regression analysis also indicated that big ET-1 was independently associated with all-cause mortality[hazard ratio(HR):6.221,95%confidence interval(CI):1.455-22.595,P<0.014].In addition,the Kaplan-Meier curves of the cumulative survival rate stratified by big ET-1 level revealed that higher levels(big ET-1>0.68 pmol/L)were associated with shorter event-free survival(P<0.05).Conclusion:Plasma big endothelin-1 is an independent prognostic marker of cardiovascular outcomes after coronary artery bypass grafting in patients with CKD. |
