Abstract 9681: Pre-Procedural Serum Albumin and C-reactive Protein Levels Predict Clinical Outcome After Endovascular Therapy in Hemodialysis Patients with Peripheral Artery Disease
Background: Although endovascular therapy (EVT) has become widely performed for peripheral artery disease (PAD), adverse events such as high restenosis rate or premature death after EVT remain major clinical problems in patients on hemodialysis (HD). On the other hand, malnutrition and chronic inflammation status are frequently observed, and linked to poor cardiovascular outcome in such population. We evaluated the possible prognostic values of serum albumin and C-reactive protein (CRP) levels on clinical outcomes after EVT in patients on HD.
Methods: A total of 450 HD patients successfully undergoing EVT for PAD were enrolled and were followed-up for up to 8 years. Serum albumin and CRP levels were measured prior to EVT. They were divided into tertiles according to serum albumin and CRP levels; the lowest tertile (T1), the middle tertile (T2) and the highest tertile (T3), respectively. We analyzed the incidence of major adverse cardiovascular events (MACE) as a composite endpoint including target lesion revascularization (TLR), amputation and all-cause death.
Results: During follow-up period (mean 36±31months), 206 MACE (46%) including 67 TLRs, 45 amputations and 94 deaths occurred. Event-free survival rate from MACE for 8 years was 23.1%, 25.9%, and 50.0% in T1, T2 and T3 of albumin (p<0.0001), and 41.2%, 36.3% and 18.9% in T1, T2 and T3 of CRP (p=0.0004), respectively. After adjustment, lower albumin (HR 2.00, 95%CI 1.29-3.10, p=0.0071 for T1 vs. T3) and elevated CRP (HR 1.93, 95%CI 1.29-2.90, p=0.0061 for T3 vs. T1) were independent predictors for MACE, respectively. Furthermore, in the combined setting of albumin and CRP, the risk of MACE was 5.22-fold (95%CI 2.34-11.64, p=0.0011) higher in the T1 of albumin with T3 of CRP compared to the T3 of albumin with T1 of CRP even after adjustment (Figure).
Conclusions: Lower albumin and elevated CRP levels could strongly predict MACE after EVT in patients on HD. However, the combination of these variables is more markedly related to increased MACE than either variable alone.
- © 2011 by American Heart Association, Inc.