In population studies, both a low ankle brachial index (ABI) and high ABI (noncompressible vessels) are associated with increased cardiovascular events and mortality. Insights into comorbid disease patterns and characteristics may improve understanding and methods for prevention, screening, and treatment of primary and secondary disease outcomes in patients undergoing peripheral revascularization. We used the Vascular Quality Initiative to determine the association of different cardiovascular disease risk factors, other prevalent cardiovascular disease and treatment aspects with differing levels of the ABI. We included adult patients with peripheral artery disease who underwent peripheral vascular intervention for peripheral artery disease from 2004 to 2020. Patients were categorized into (1) ABI of less than 0.3, (2) ABI of 0.3 to 1.4, and (3) ABI of greater than 1.4 based on the primary treated leg undergoing revascularization. Multivariable multinomial logistic regression was used to study the association between variables of interest and differing levels of the ABI. There were 161,474 participants with a preprocedure ABI who underwent a peripheral vascular intervention (17,034 ABI <0.3; 128,978 ABI 0.3-1.4; and 15,462 ABI >1.4). Male patients had 16% lower odds of having an ABI of less than 0.3 (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.81-0.87) and 81% higher odds of having ABI of greater than 1.4 (OR, 1.81; 95% CI, 1.74-1.89), compared with an ABI of 0.3 to 1.4. Current smokers had 12% higher odds (OR, 1.12; 95% CI, 1.06-1.18) of having an ABI of less than 0.3 and 71% lower odds (OR, 0.29; 95% CI, 0.27-0.30) of an ABI of greater than 1.4. Additionally, individuals on dialysis (OR, 5.40; 95% CI, 5.15-5.68) or with insulin-dependent diabetes (OR, 2.71; 95% CI, 2.59-2.84) had higher odds of an ABI of greater than 1.4, with increased, but less odds, for dialysis (OR, 1.90; 95% CI, 1.79-2.03) and insulin-dependent diabetes (OR, 1.08; 95% CI, 1.04-1.13) for odds of an ABI of less than 0.3. Individuals with an ABI of less than 0.3 typically manifest significant lesions in the iliac and/or femoral vessels, while those with an ABI of greater than 1. individuals exhibit more distal disease in the popliteal and/or tibial vessels. High ABI individuals had higher odds of congestive heart failure (OR, 2.07; 95% CI, 1.97-2.17) and atrial/ventricular dysrhythmias (Table). Interestingly, while high ABI had higher odds of prior stroke (OR, 1.27; 95% CI, 1.20-1.34), they had 38% lower odds (OR, 0.62; 95% CI, 0.57-0.68) of having undergone carotid revascularization. Other cardiovascular disease and anatomic considerations of the primary treated target lesion are presented in the Table. Patients with very low ABI and falsely elevated ABI presenting for endovascular interventions possess differing lesion anatomy and concomitant cardiovascular disease characteristics. This study highlights that ABI not only helps with preprocedure planning of the endovascular interventions, but also further highlights the multiple vascular beds involved in individuals with peripheral artery disease and need for comprehensive evaluation and screening in cardiac and other vascular beds.TableAssociations of other cardiovascular disease and treated artery location with varying levels of the preprocedure ankle-brachial index (ABI) (Vascular Quality Initiative: 2004-2020; n = 161,474)ABI <0.3 vs 0.3-1.4ABI >1.4 vs 0.3-1.4Other cardiovascular disease History of congestive heart failure1.26 (1.19-1.33)2.07 (1.97-2.17) History of myocardial infarction1.04 (0.98-1.10)1.03 (0.98-1.09) Prior coronary procedure0.88 (0.83-0.92)1.14 (1.09-1.20)History of stroke1.15 (1.08-1.22)1.27 (1.20-1.34)Prior carotid procedure1.06 (0.98-1.14)0.62 (0.57-0.68)DysrhythmiaNone1 (Ref)1 (Ref)Atrial1.17 (1.09-1.25)1.95 (1.84-2.06)Ventricular1.14 (0.91-1.41)1.58 (1.31-1.91)Atrioventricular block w/pacemaker0.97 (0.85-1.10)1.89 (1.71-2.07)Implantable cardioverter-defibrillator0.98 (0.86-1.13)1.41 (1.27-1.56)Other0.66 (0.27-1.66)1.84 (1.01-3.34)Primary treated artery Superficial femoral1 (Ref)1 (Ref) Aorta2.70 (1.26-5.80)1.94 (0.67-5.58) Common/external iliac1.84 (1.76-1.93)0.74 (0.69-0.79) Common femoral1.73 (1.59-1.89)1.02 (0.90-1.15) Profunda2.80 (2.38-3.28)1.25 (0.98-1.59) Popliteal1.10 (1.03-1.17)1.55 (1.47-1.65) Superficial femoral artery/popliteal1.35 (1.26-1.44)1.18 (1.10-1.27) Tibial0.84 (0.79-0.89)2.07 (1.97-2.17) Internal iliac1.08 (0.49-2.36)0.95 (0.41-2.18)Presents are odds ratios (95% confidence intervals) from multinomial logistic regression with ABI range 0.3-1.4 as reference group. Model adjusts for age, sex, race, and Hispanic ethnicity. Bold signifies P < .05. Open table in a new tab