基质金属蛋白酶(MMPs)和金属蛋白酶组织抑制剂(TIMPs)与冠状动脉疾病(CAD)患者的临床结果有关。然而,TIMP-1在接受冠状动脉旁路移植术(CABG)的CAD患者中的预后价值尚未阐明.我们旨在研究TIMP-1与高敏C反应蛋白(hs-CRP)和N末端脑钠肽前体(NT-proBNP)在连续CABG患者长期预后中的相关性。
■共有234名患者(年龄:70.4±10.5岁,84.6%的男性)接受CABG的CAD患者被前瞻性纳入。术前MMPs水平,TIMP-1,hs-CRP,记录NT-proBNP。主要不良心血管事件(MACE)定义为非致死性心肌梗死,非致命性中风,心血管死亡。
■在12.1年的中位随访期间,记录了120人死亡。死者年龄较大,有更明显的急性冠脉综合征(ACS),较低的左心室射血分数(LVEF),和估计的肾小球滤过率(eGFR),但显著高于MMP13,TIMP-1,hs-CRP,和NT-proBNP与幸存者相比。在调整了年龄之后,性别,清单ACS,eGFR,LVEF,总胆固醇,和甘油三酯,TIMP-1(每SD的风险比和95%置信区间:1.506,1.183-1.917),hs-CRP(1.349,1.183-1.561),NT-ProBNP(1.707,1.326-2.199)均与全因死亡率独立相关.中介分析显示,TIMP-1的死亡风险部分由NT-proBNP(62.2%)和hs-CRP(25.3%)介导。TIMP-1与MACE的相关性部分由NT-proBNP介导(54.4%),而非hs-CRP。
■TIMP-1是CABG术后长期结局的独立预测因子,可能在亚临床炎症和术后心脏重塑中发挥作用。
UNASSIGNED: Matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) have been linked to clinical outcomes in patients with coronary artery disease (CAD). However, the prognostic value of TIMP-1 in patients with CAD who underwent coronary artery bypass grafting (CABG) has not been elucidated. We aimed to investigate the correlations of TIMP-1 with high-sensitivity C-reactive protein (hs-CRP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in the long-term prognosis of consecutive patients who underwent CABG.
UNASSIGNED: A total of 234 patients (age: 70.4 ± 10.5 years, 84.6% men) with CAD who underwent CABG were prospectively enrolled. Preoperative levels of MMPs, TIMP-1, hs-CRP, and NT-proBNP were recorded. Major adverse cardiovascular events (MACE) were defined as non-fatal myocardial infarction, non-fatal stroke, and cardiovascular death.
UNASSIGNED: During a median follow-up of 12.1 years, 120 deaths were recorded. The deceased were older, had more manifest acute coronary syndrome (ACS), a lower left ventricular ejection fraction (LVEF), and an estimated glomerular filtration rate (eGFR), but significantly higher MMP13, TIMP-1, hs-CRP, and NT-proBNP compared with the survivors. After adjusting for age, sex, manifest ACS, eGFR, LVEF, total cholesterol, and triglycerides, TIMP-1 (hazard ratio and 95% confidence intervals per SD: 1.506, 1.183-1.917), hs-CRP (1.349, 1.183-1.561), and NT-ProBNP (1.707, 1.326-2.199) were all independently associated with all-cause mortality. The mediation analysis revealed that the mortality risks of TIMP-1 were partially mediated by NT-proBNP (62.2%) and hs-CRP (25.3%). The associations of TIMP-1 with MACE were partially mediated by NT-proBNP (54.4%) but not hs-CRP.
UNASSIGNED: TIMP-1 was an independent predictor of long-term outcomes after CABG, with possible roles in subclinical inflammation and postoperative cardiac remodeling.