043 Does routine measurement of ankle brachial index ameliorates the assessment of coronary risk level in patients with known or suspected coronary artery disease. The ABICARD study

Abstract

Ankle-brachial pressure index (ABI) is an independent predictor of the extent of coronary atherosclerosis and cardiovascular events. To date ABI measurement is not part of the routine examination in patient admitted for coronary angiography. Our objective was to establish ABI measurement as a routine procedure in our interventional cardiology unit to ameliorate the assessment of coronary risk level for patients admitted for scheduled coronary angiography. ABI measurement was performed on admission using a doppler ultrasonic instrument. Patients with past medical history of peripheral arteriopathy were excluded. Cardiovascular risk factors and clinical findings were collected. Correlations and multivariate analysis were performed on R software. In the pilot study, 40 consecutive patients were included between February and April 2009. 79% were males and the mean age was 66+/-12 years. ABI < 0.9 was found in 6 patients. Significant multivessel disease was found in 10 patients: 6 with ABI<0.9 and 4 with ABI≥0.9. Patients with ABI<0.9 were significantly older 75+/-11 vs 64+/-12 (p=0.04) and had a trend for lower glomerular filtration rate MDRD=61+/-21 vs 77+/-20 mL/min/1.73m_ (p=0.08). 5-years probability of cardiovascular death was 12+/-7.4% in patients with ABI<0.9 vs 7.2+/-7.6 in patients with ABI≥0.9 (p=ns). Multivariate analysis showed that ABI remains a significant predictor of multivessel disease after adjustment on other risk factors. Low ABI was significantly correlated with 5 years probability of cardiovascular death (spearman = −0.36, P=0.03). ABI was an independent predictor of coronary multivessel disease and 5 years probability of cardiovascular death. Routine ABI measurement in patients with known or suspected coronary artery disease provides additional information regarding patient's risk and may be taken into account to establish optimal care strategy.