Prognostic Value of the Ankle-Brachial Index in Patients Undergoing Drug-Eluting Stent Implantation

Abstract

Limited data are available regarding the prognostic value of the brachial-ankle index (ABI) in patients with a history of drug-eluting stent (DES) implantation. This study sought to determine the relationship between the ABI and coronary events in patients with DES. A total of 322 patients who underwent both DES implantation and ABI measurement during initial hospitalization were reviewed. Cardiovascular events, including cardiac death, non-fatal acute myocardial infarction and coronary revascularization, were assessed. During the mean follow-up period of 298 ± 58 days, there were 32 cases of cardiovascular events (9.9%). The patients with a lower ABI had more events (2.8% in the highest tertile versus 10.3% in the middle tertile versus 16.8% in the lowest tertile, p = 0.001). According to the multiple Cox regression analysis, the ABI was independently associated with clinical events (the lowest tertile versus the highest tertile of ABI, hazard ratio: 6.35, 95% confidence interval: 1.37-29.32, p=0.018). In addition, the cumulative event rate according to the ABI tertile differed significantly in the Kaplan-Meier curves (log-rank p=0.009), whereas the receiver-operating characteristic curve analysis showed a sensitivity and specificity for predicting cardiovascular events of 62.5% and 66.2%, respectively, with an ABI of 1.057 as the best cut-off value. A lower ABI is associated with poorer cardiovascular outcomes in patients with DES implantation. As a simple and non-invasive parameter, the ABI has the benefit of predicting future cardiovascular events in this population.