Abstract
Background
An abnormal ankle-brachial pressure index (ABI) is a marker of the risk for increased
total and cardiovascular (CV) mortality. However, it is not clear whether it is associated
with an even worse prognosis in patients with previous CV events or with cancer mortality.
Materials and Methods
Consecutive subjects undergoing ABI assessment for suspected peripheral artery disease
or for stratification of CV risk in ten centers in the Veneto Region (northeast Italy),
between 2011 and 2014 were enrolled. The ABI was expressed as normal ≥0.9 to ≤1.3,
and abnormal <0.9 or >1.3. All-cause mortality and CV or cancer mortality and hospitalizations
for CV disease were collected from administrative databases up to December 2018.
Results
The study enrolled 1,177 patients. ABI was abnormal in 57.2%. Median follow-up was
61.6 months (53.4–70.1). All-cause, CV and cancer mortality were higher in patients
with abnormal than normal ABI, with hazard ratios (HR) respectively 2.0 (95% CI 1.48–2.69),
1.98 (95% CI 1.24–3.17) and 1.85 (95% CI 1.09–3.15). Among subjects with abnormal
ABI, the risk of overall mortality, HR 1.57 (95% CI 1.17–2.12), and CV mortality,
HR 2.39 (95% CI 1.43–3.99), was higher in those with previous CV events. These latter
also had a higher risk of hospitalization for myocardial infarction and stroke: HR
1.85 (95% CI 1.023.37) and 2.17 (95% CI 1.10–4.28).
Conclusions
The co-existence of abnormal ABI and a history of CV events identifies subjects at
higher risk, who call for a more aggressive approach. Abnormal ABI is also a predictor
of cancer mortality.
Keywords
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References
- ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for vascular surgery (ESVS): document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries endorsed by: the European stroke organization (ESO) the task force for the diagnosis and treatment of peripheral arterial diseases of the european society of cardiology (ESC) and of the European society for vascular surgery (ESVS).Eur Heart J. 2018; 39: 763-816
- Peripheral arterial disease: morbidity and mortality implications.Circulation. 2006; 114: 688-699
- Global, regional, and national prevalence and risk factors for peripheral artery disease in 2015: an updated systematic review and analysis.Lancet Glob Health. 2019; 7: e1020-e1030
- Inter-Society consensus for the management of peripheral arterial disease (TASCII).Eur J Vasc Endovasc Surg. 2007; 33: S1-75
- Epidemiology of peripheral artery disease.Circ Res. 2015; 116: 1509-1526
- Diagnostic value of ankle-brachial index in peripheral arterial disease: a metaanalysis.Can J Cardiol. 2013; 29: 492-498
- Ankle brachial index combined with Framingham risk score to predict cardiovascular events and mortality: a meta-analysis.JAMA. 2008; 300: 197-208
- German epidemiological trial on ankle brachial index study group. mortality and vascular morbidity in older adults with asymptomatic versus symptomatic peripheral artery disease.Circulation. 2009; 120: 2053-2061
- Ticagrelor for prevention of ischemic events after myocardial infarction in patients with peripheral artery disease.J Am Coll Cardiol. 2016; 67: 2719-2728
- Extended duration dual antiplatelet therapy after coronary stenting among patients with peripheral arterial disease: a subanalysis of the dual antiplatelet therapy study.JACC Cardiovasc Interv. 2017; 10: 942-954
- One-year cardiovascular event rates in outpatients with atherothrombosis.JAMA. 2007; 297: 1197-1206
- Low ankle-brachial index predicts an adverse 1-year outcome after acute coronary and cerebrovascular events.J Thromb Haemost. 2006; 4: 2599-2606
- Prevalence of peripheral arterial disease in patients with acute coronary síndrome (PAMISCA) investigators. prevalence and prognostic influence of peripheral arterial disease in patients >or=40 years old admitted into hospital following an acute coronary event.Eur J Vasc Endovasc Surg. 2008; 36: 189-196
- The possible risk of cancer in claudicants.Angiology. 2011; 62: 579-584
- Cancer risk and subsequent survival after hospitalization for intermittent claudication.Cancer Epidemiol Biomark Prev. 2015; 24: 744-748
- The fate of patients with intermittent claudication in the 21st century revisited - results from the CAVASIC Study.Sci Rep. 2017; 8: 45833
- Morbidity and mortality associated with atherosclerotic peripheral artery disease: a systematic review.Atherosclerosis. 2019; (piiS0021-9150(19)31499-6)https://doi.org/10.1016/j.atherosclerosis.2019.09.012
- 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes.Eur Heart J. 2019; (piiehz425)
- Management of hyperlipidemia in patients with vascular disease.J Vasc Nurs. 2003; 21: 63e67
- Low ankle-brachial index predicts cardiovascular risk after acute ischemic stroke or transient ischemic attack.Stroke. 2009; 40: 3700-3705
- Predictive value of ankle brachial index in patients with acute ischaemic stroke.Eur J Neurol. 2010; 17: 602-606
- Associations of ankle-brachial index (ABI) with cerebral arterial disease and vascular events following ischemic stroke.Atherosclerosis. 2012; 223: 219-222
- Predictive value of the ankle brachial index in patients with acute ischemic stroke.Vasa. 2014; 43: 55-61
- Evolocumab and clinical outcomes in patients with cardiovascular disease.N Engl J Med. 2017; 376: 1713-1722
- Alirocumab and cardiovascular outcomes after acute coronary syndrome.N Engl J Med. 2018; 379: 2097-2107
- Rivaroxaban with or without aspirin in stable cardiovascular disease.N Engl J Med. 2017; 377: 1319-1330
- The relationship between ankle-arm index and mortality in older men and women.J Am Geriatr Soc. 1993; 41: 523-530
- Atherosclerosis and cancer; a resemblance with far-reaching implications.Arch Med Res. 2017; 48: 12-26
- Shared risk factors in cardiovascular disease and cancer.Circulation. 2016; 133: 1104-1114
- Smoking status and incidence of cancer after myocardial infarction: a follow-up study of over 20 years.Am J Med. 2017; 130: 1084-1091
- ESVM Guideline on peripheral arterial disease.Vasa. 2019; 48: 1-79https://doi.org/10.1024/0301-1526/a000834
Article info
Publication history
Published online: March 06, 2020
Accepted:
February 29,
2020
Received in revised form:
February 8,
2020
Received:
November 28,
2019
Identification
Copyright
© 2020 Published by Elsevier B.V. on behalf of European Federation of Internal Medicine.
