Serum Cholinesterase Levels Are Associated With 2-Year Ischemic Outcomes After Angioplasty and Stenting for Peripheral Artery Disease

J Endovasc Ther. 2016 Oct;23(5):738-43. doi: 10.1177/1526602816655521. Epub 2016 Jun 20.

Abstract

Purpose: To prospectively investigate the associations of serum cholinesterase (CHE) levels with ischemic outcomes after angioplasty and stenting for lower limb peripheral artery disease (PAD).

Methods: A prospective cohort study enrolled 108 patients with Rutherford category 2-3 ischemia who had successful primary unilateral angioplasty and self-expanding bare metal stent implantation for superficial femoral artery (SFA) stenosis. The primary endpoint was a composite of nonfatal myocardial infarction, nonfatal stroke or transient ischemic attack, cardiovascular death, or >80% target lesion restenosis within 2 years after peripheral angioplasty. Target lesion restenosis (restenosis endpoint) and the composite of the aforementioned atherothrombotic events (atherothrombotic endpoint) within 2-year follow-up were defined as secondary endpoints.

Results: CHE levels were not available in 4 patients due to technical problems and 4 patients were lost to follow-up. The remaining 100 patients (median age 65 years; 62 men) met the minimum sample size requirement for statistical analysis. Median CHE levels were significantly lower in patients who subsequently experienced the primary endpoint compared with patients without ischemic events [7.1 (IQR 6.3-8.1) vs 8 (IQR 7-9.3) kU/L, p=0.007]. A CHE level <8.3 kU/L was identified as the best cutoff value to predict the primary endpoint, providing an 82.1% sensitivity and 44.3% specificity. The primary endpoint occurred significantly more often in patients with low CHE <8.3 kU/L than in patients with higher CHE levels (32 vs 7 patients, p=0.01). In multivariable Cox regression analysis, low CHE was associated with a 2.6-fold increased risk (95% CI 1.1 to 5.9, p=0.03) of the primary endpoint. Moreover, patients who suffered the secondary restenosis endpoint had significantly lower median CHE levels than patients without restenosis [7.1 (IQR 6.3-8.2) vs 7.9 (IQR 7-8.9) kU/L, p=0.02], and restenosis occurred more frequently in patients with low CHE compared with those with higher CHE levels (27 vs 7 patients, p=0.04).

Conclusion: Low CHE is associated with an increased risk of long-term adverse ischemic events following SFA angioplasty with stent implantation for PAD.

Keywords: angioplasty; complications; peripheral artery disease; restenosis; serum cholinesterase; stent implantation; superficial femoral artery.

MeSH terms

  • Aged
  • Angioplasty / adverse effects
  • Angioplasty / instrumentation*
  • Angioplasty / mortality
  • Biomarkers / blood
  • Chi-Square Distribution
  • Cholinesterases / blood*
  • Down-Regulation
  • Female
  • Humans
  • Ischemia / blood
  • Ischemia / diagnosis
  • Ischemia / mortality
  • Ischemia / therapy*
  • Ischemic Attack, Transient / etiology
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Infarction / etiology
  • Peripheral Arterial Disease / blood
  • Peripheral Arterial Disease / diagnosis
  • Peripheral Arterial Disease / mortality
  • Peripheral Arterial Disease / therapy*
  • Proportional Hazards Models
  • Prospective Studies
  • Prosthesis Design
  • Recurrence
  • Risk Factors
  • Self Expandable Metallic Stents*
  • Stroke / etiology
  • Time Factors
  • Treatment Outcome

Substances

  • Biomarkers
  • Cholinesterases