• D J Newton, F Khan, M McLaren, G Kennedy, and J J F Belch.
• Vascular Diseases Research Unit, Institute of Cardiovascular Research, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK. d.j.newton@dundee.ac.uk
• Br J Surg. 2005 Nov 1; 92 (11): 137713811377-81.

BackgroundMost patients with critical leg ischaemia (CLI) have co-existing coronary heart disease, which is the main cause of their increased mortality rate. The aim of this study was to investigate whether any markers of endothelial function could predict death in these patients.MethodsIn a cohort of 39 patients with CLI who were scheduled for lower-limb amputation, blood levels of vascular endothelial growth factor, homocysteine, endothelin (ET) 1, von Willebrand factor and vascular cell adhesion molecule 1 were measured, as well as forearm vascular responses to the endothelium-dependent vasodilator acetylcholine.ResultsLevels of ET-1 were significantly higher in patients who subsequently died within 3 years than in those who were still alive (P = 0.002) and Cox proportional hazards regression analysis demonstrated that ET-1 was an independent predictor of all-cause mortality:hazard ratio 3.53 (95 per cent confidence interval (c.i.) 1.29 to 9.70; P = 0.007) and cardiovascular mortality:hazard ratio 4.15 (95 per cent c.i. 1.30 to 13.23); P = 0.014.ConclusionET-1 was an independent predictor of death in these patients with CLI.

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