低栄養・炎症・動脈硬化の併存が血管内治療後の下肢末梢動脈疾患患者の予後に及ぼす影響

Abstract

鹿児島大学博士(医学)Doctor of Philosophy in Medical Science博士論文全文, 博士論文要旨, 最終試験結果の要旨, 論文審査の要旨Malnutrition and inflammation are common problems of adverse outcomes in various diseases as atherosclerosis. Recently, the concept of malnutrition-inflammation-atherosclerosis (MIA) syndrome is known to a crucial prognostic factor in patients with end-stage renal disease. We investigated the prognostic impact of the co-presence of MIA factors in patients with lower-extremity artery disease (LEAD) after endovascular therapy (EVT). This retrospective study included 284 patients with LEAD who underwent EVT. MIA factors were defined in patients with: low geriatric nutritional risk index (< 92) as “malnourished”; greater high-sensitivity C-reactive protein levels (≥ 0.1 mg/dL) as “inflamed”; a history of coronary artery revascularization, lacunar or atherothrombotic brain infarction as “atherosclerotic”. We examined the relationship between baseline characteristics and major adverse cardiovascular and cerebrovascular events (MACCE) including all-cause mortality. Sixty-two patients (22%) died and 72 patients (25%) had MACCE, including all-cause death. Forty-four (16%) patients had every 3 of MIA (3-MIA) factors. The mean follow-up period was 737 days. Multivariate Cox proportional hazards regression analysis models revealed that 3-MIA factors correlated significantly with all-cause death [hazard ratio (HR) 3.46, 95% confidence interval (CI) 1.89–6.34; p < 0.001] and MACCE (HR 2.91, 95% CI 1.62–5.22; p < 0.001), after adjusting for relevant factors. Kaplan–Meier analysis revealed that the rates of all-cause death (p < 0.001) and MACCE (p < 0.001) were significantly higher when the MIA factors overlapped and are observed in patients with chronic limb-threatening ischemia. Among patients with LEAD after EVT, the co-presence of MIA factors was an independent risk factor for all-cause death and MACCE.Kenta Ohmure, Daisuke Kanda, Yoshiyuki Ikeda, Akihiro Tokushige, Takeshi Sonoda, Ryo Arikawa, Kazuhiro Anzaki & Mitsuru Ohishi Impact of co-presence of malnutrition-inflammation-atherosclerosis factors on prognosis in lower extremity artery disease patients after endovascular therapy Cardiovasc Interv and Ther 40, 102–111 (2025) https://doi.org/10.1007/s12928-024-01058-6The version of record of this article, first published in Cardiovascular Intervention and Therapeutics , is available online at Publisher’s website: https://doi.org/10.1007/s12928-024-01058-6doctoral thesi