Abstract
Ankle-brachial pressure index (ABPI) is commonly measured in people referred to vascular specialists. This study aimed to assess the association of high ABPI (≥ 1.4) with cardiovascular events in people with peripheral artery disease (PAD). 1533 participants with PAD diagnosed by a vascular specialist were prospectively recruited from four out-patient clinics in Australia. ABPI was measured at recruitment and the occurrence of myocardial infarction (MI), stroke or cardiovascular death (major cardiovascular events; MACE) and any amputation were recorded over a median (inter-quartile range) follow-up of 3.3 (1.0–7.1) years. The association of high, compared to normal, low (0.5–0.9) or very low (<0.5), ABPI with clinical events was estimated using Cox proportional hazard analyses, adjusting for traditional risk factors and reported as hazard ratio with 95% confidence intervals. 596 (38.9%), 676 (44.1%), 157 (10.2%) and 104 (6.8%) participants had normal, low, very low and high ABPI, respectively. Participants with high ABPI had increased risk of MACE, MI and death by comparison to those with either normal ABPI [1.69 (1.07, 2.65), 1.93 (1.07, 3.46) and 1.67 (1.09, 2.56)] or either low or very low ABPI [1.51 (1.02, 2.23), 1.92 (1.16, 3.19) and 1.47 (1.02, 2.14)] after adjusting for other risk factors. Findings were similar in a sensitivity analysis excluding people with ABPI only measured in one leg (n = 120). Participants with high ABPI also had an increased risk of MACE and MI compared to those with very low ABPI alone. High ABPI is a strong indicator of excess risk of cardiovascular events amongst people with PAD.
Highlights
Cox proportional hazard analyses assessed the association of high Ankle-brachial pressure index (ABPI), compared to normal or low or very low ABPI combined ( 0.90), with events adjusted for other risk factors including age, sex, presentation, current smoking, diabetes, hypertension, Ischemic heart disease (IHD), stroke, end-stage renal failure, prescription of statins, anti-coagulants, anti-platelets and furosemide
Risk factors associated with high ABPI
Shown are hazard ratios (95% confidence intervals) for events in comparison to participants with normal or low ABPI
Summary
Ankle-brachial pressure index (ABPI), the ratio between systolic pressure at the ankle and arm, is recommended by current guidelines as a diagnostic test for peripheral artery disease. Population studies report that about 3 to 5% of people have an abnormally high ABPI, commonly defined as 1.4 [3, 7,8,9] In these instances, the test is typically concluded to not be able to provide diagnostic information about PAD and it is currently unclear how such patients should be managed [1, 2, 10]. This study aimed to clarify the risk factors and prognostic implications of a high ABPI in a hospital population with established vascular disease. This study had two aims, firstly, to identify risk factors associated with high ABPI, and secondly, to compare the risk of MACE, amputation and all-cause mortality for PAD patients with high ABPI, to those of PAD patients with normal or low ABPI
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