The prognostic value of the serum eicosapentaenoic acid to arachidonic acid ratio in relation to clinical outcomes after endovascular therapy in patients with peripheral artery disease caused by femoropopliteal artery lesions.
BACKGROUND
The EPA/AA ratio has emerged as a predictor of mortality endpoints in cardiac disease; however, its prognostic value in peripheral artery disease (PAD) patients is unclear. We assessed the serum eicosapentaenoic acid (EPA) to arachidonic acid (AA) ratio in patients with PAD caused by femoropopliteal artery lesions, to determine whether it predicts clinical outcomes after endovascular therapy (EVT).


RESULTS
We obtained serum EPA/AA ratios from 132 consecutive patients with PAD caused by femoropopliteal artery lesions before EVT. Patients were divided into two groups using the median value of serum EPA/AA ratios of the entire cohort; LOW group with the levels ≤0.30 (n = 66) and HIGH group >0.30 (n = 66). The incidence of major adverse events (MAE), including major adverse limb events (MALE) and death from any cause, was determined. At a median follow-up interval of 24 months, MALE occurred in 40 patients (30.3%) and 11 patients (8.3%) died. Kaplan-Meier curve analysis demonstrated the survival probability from MAE was significantly worse in patients with EPA/AA ratio under the median (long-rank test χ(2) = 16.4; p < 0.001). Multivariate Cox regression analysis showed critical limb ischemia (hazard ratio [HR]: 3.44; 95% confidence interval [CI]: 1.84 to 6.46; p < 0.001) and the preprocedural serum EPA/AA ratios ≤0.30 (HR: 2.74; 95% CI: 1.33 to 5.65; p = 0.006) independently predicted MAE after EVT.


CONCLUSIONS
Lower serum EPA/AA ratios appear to be associated with a greater risk of MALE and death from any cause after EVT in patients with PAD caused by femoropopliteal artery lesions.
Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan; Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Keiichi
K
Hishikari
Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan. Electronic address: shigeki55@nifty.com.
Shigeki
S
Kimura
Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
Yosuke
Y
Yamakami
Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
Keisuke
K
Kojima
Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
Yuichiro
Y
Sagawa
Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
Hirohumi
H
Otani
Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
Tomoyo
T
Sugiyama
Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
Taishi
T
Kuwahara
Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
Hiroyuki
H
Hikita
Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka, Japan.
Atsushi
A
Takahashi
Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
Mitsuaki
M
Isobe
D000368:Aged; D016718:Arachidonic Acid / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003251:Constriction, Pathologic; D003404:Creatinine / Q000652:urine; D015536:Down-Regulation; D015118:Eicosapentaenoic Acid / Q000097:blood*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005263:Femoral Artery; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000097:blood* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D011150:Popliteal Artery; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D016718:Arachidonic Acid; D015118:Eicosapentaenoic Acid; D003404:Creatinine
Arachidonic acid; Eicosapentaenoic acid; Endovascular therapy; Femoropopliteal artery; Outcome; Peripheral artery disease; Prognosis