Abstract
BackgroundThe ankle—brachial index (ABI) is a marker of generalized atherosclerosis and is predictive of future cardiovascular events. However, few studies have assessed its relation to long-term future cardiovascular events, especially in patients with borderline ABI. We therefore evaluated the relationship between long-term future cardiovascular events and ABI.MethodsIn the IMPACT-ABI study, a single-center, retrospective cohort study, we enrolled 3131 consecutive patients (67 ± 13 years; 82% male) hospitalized for cardiovascular disease and measured ABI between January 2005 and December 2012. After excluding patients with an ABI > 1.4, the remaining 3056 patients were categorized as having low ABI (≤ 0.9), borderline ABI (0.91–0.99), or normal ABI (1.00–1.40). The primary endpoint was MACE (cardiovascular death, myocardial infarction [MI] and stroke). The secondary endpoints were cardiovascular death, MI, stroke, admission due to heart failure, and major bleeding.ResultsDuring a 4.8-year mean follow-up period, the incidences of MACE (low vs. borderline vs. normal: 32.9% vs. 25.0% vs. 14.6%, P<0.0001) and cardiovascular death (26.2% vs. 18.7% vs. 8.9%, P<0.0001) differed significantly across ABIs. The incidences of stroke (9.1% vs. 8.6% vs. 4.8%, P<0.0001) and heart failure (25.7% vs. 20.8% vs. 8.9%, P<0.0001) were significantly higher in the low and borderline ABI groups than in the normal ABI group. But the incidences of MI and major bleeding were similar in the borderline and normal ABI groups. The hazard ratios for MACE adjusted for traditional atherosclerosis risk factors were significantly higher in patients with low and borderline ABI than those with normal ABI (HR, 1.93; 95%CI: 1.44–2.59, P < 0.0001, HR, 1.54; 95% CI: 1.03–2.29, P = 0.035).ConclusionsThe incidence of long-term adverse events was markedly higher among patients with low or borderline ABI than among those with normal ABI. This suggests that more attention should be paid to patients with borderline ABIs, especially with regard to cardiovascular death, stroke, and heart failure.
Highlights
The incidences of stroke (9.1% vs. 8.6% vs. 4.8%, P
The hazard ratios for MACE adjusted for traditional atherosclerosis risk factors were significantly higher in patients with low and borderline ABI than those with normal ABI (HR, 1.93; 95%CI: 1.44–2.59, P < 0.0001, HR, 1.54; 95% CI: 1.03–2.29, P = 0.035)
The incidence of long-term adverse events was markedly higher among patients with low or borderline ABI than among those with normal ABI
Summary
The ankle-brachial index (ABI) is a useful tool for specific, cost-effective, noninvasive diagnosis for peripheral artery disease. [1, 2] Between 9% and 23% of people over 55 years of age are affected by peripheral artery disease [3, 4] Among them, only 10% exhibit the typical symptoms of intermittent claudication, whereas 50% have other leg symptoms and the remaining 40% are asymptomatic. [5, 6] a low ABI ( 0.9) is strongly associated with generalized atherosclerosis, cardiovascular mortality and all-cause death, regardless of the presence of symptoms. [7, 8] Recently, the American College of Cardiology and the American Heart Association (ACC/AHA) guidelines for the management of peripheral artery disease patients recommended that 0.91 ABI 0.99 be considered borderline, and that patients with borderline ABI should be considered a high risk group, similar to patients with an abnormal ABI (ABI 0.9). [9, 10] there were few data available on the long-term future cardiovascular events in patients with borderline ABI, especially among the hospitalized cardiology population, who are admitted to the hospital most frequently. [9, 10] there were few data available on the long-term future cardiovascular events in patients with borderline ABI, especially among the hospitalized cardiology population, who are admitted to the hospital most frequently. There is a clear necessity for real-world data on the long-term likelihood of future cardiovascular events in patients with ABI 0.9, especially among the hospitalized cardiology population with borderline ABI. We evaluated the relationship between the long-term future cardiovascular events and ABI among the hospitalized cardiology population. The ankle—brachial index (ABI) is a marker of generalized atherosclerosis and is predictive of future cardiovascular events. Few studies have assessed its relation to longterm future cardiovascular events, especially in patients with borderline ABI. We evaluated the relationship between long-term future cardiovascular events and ABI
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