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Different calculations of ankle-brachial index and their impact on cardiovascular risk prediction.
Circulation. 2008 Aug 26; 118(9):961-7.Circ

Abstract

BACKGROUND

An ankle-brachial index (ABI; ratio of ankle and brachial systolic blood pressure) <0.9 indicates peripheral arterial disease (PAD) and is a strong predictor of cardiovascular events. The aim of the present study was to address the prognostic value of different methods of ABI calculation.

METHODS AND RESULTS

In 831 patients admitted with chest pain for diagnostic heart catheterization, blood pressure of both anterior and posterior tibial arteries was measured. ABI was calculated for each leg with the higher of the 2 ankle pressures (current definition of the American Heart Association) or with the lower of the 2 ankle pressures (modified definition) in relation to the higher of the left or right brachial systolic blood pressure. For each patient, the lower ABI from both legs was used for further evaluation. Fifteen patients (1.8%) with ABI >1.5 were excluded. We compared patients with ABI <0.9 according to the current definition (with PAD, n=204 [25.0%]), those with ABI >or=0.9 according to the modified definition (without PAD, n=524 [64.2%]), and those with ABI <0.9 according to the modified definition and >or=0.9 according to the current definition (suspected PAD, n=88 [10.8%]). Follow-up data (median 6.6 years) were available for 812 patients (99.5%); 157 patients (19.3%) experienced cardiovascular events (cardiovascular death, myocardial infarction, or stroke). Patients without PAD had the lowest cardiovascular event rate, whereas event rates were comparable for patients with PAD and those with suspected PAD (14.8% versus 28.4% versus 25.0%, respectively). In a fully adjusted Cox regression analysis that included patients without PAD as the reference group, the hazard ratio (95% CI) was 1.56 (0.97 to 2.53) for patients with suspected PAD and 1.67 (1.16 to 2.40) for patients with PAD.

CONCLUSIONS

When the higher ankle pressure is used for ABI calculation, a group of patients at high risk for cardiovascular events is overlooked. With a simple modification of ABI (use of the lower instead of the higher ankle pressure), more patients at risk could be identified.

Authors+Show Affiliations

Medical Department II, Johannes Gutenberg University, Langenbeckstrasse 1, 55131 Mainz, Germany. espinola@uni-mainz.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18697822

Citation

Espinola-Klein, Christine, et al. "Different Calculations of Ankle-brachial Index and Their Impact On Cardiovascular Risk Prediction." Circulation, vol. 118, no. 9, 2008, pp. 961-7.
Espinola-Klein C, Rupprecht HJ, Bickel C, et al. Different calculations of ankle-brachial index and their impact on cardiovascular risk prediction. Circulation. 2008;118(9):961-7.
Espinola-Klein, C., Rupprecht, H. J., Bickel, C., Lackner, K., Savvidis, S., Messow, C. M., Munzel, T., & Blankenberg, S. (2008). Different calculations of ankle-brachial index and their impact on cardiovascular risk prediction. Circulation, 118(9), 961-7. https://doi.org/10.1161/CIRCULATIONAHA.107.763227
Espinola-Klein C, et al. Different Calculations of Ankle-brachial Index and Their Impact On Cardiovascular Risk Prediction. Circulation. 2008 Aug 26;118(9):961-7. PubMed PMID: 18697822.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Different calculations of ankle-brachial index and their impact on cardiovascular risk prediction. AU - Espinola-Klein,Christine, AU - Rupprecht,Hans J, AU - Bickel,Christoph, AU - Lackner,Karl, AU - Savvidis,Savvas, AU - Messow,Claudia M, AU - Munzel,Thomas, AU - Blankenberg,Stefan, AU - ,, Y1 - 2008/08/12/ PY - 2008/8/14/pubmed PY - 2008/9/18/medline PY - 2008/8/14/entrez SP - 961 EP - 7 JF - Circulation JO - Circulation VL - 118 IS - 9 N2 - BACKGROUND: An ankle-brachial index (ABI; ratio of ankle and brachial systolic blood pressure) <0.9 indicates peripheral arterial disease (PAD) and is a strong predictor of cardiovascular events. The aim of the present study was to address the prognostic value of different methods of ABI calculation. METHODS AND RESULTS: In 831 patients admitted with chest pain for diagnostic heart catheterization, blood pressure of both anterior and posterior tibial arteries was measured. ABI was calculated for each leg with the higher of the 2 ankle pressures (current definition of the American Heart Association) or with the lower of the 2 ankle pressures (modified definition) in relation to the higher of the left or right brachial systolic blood pressure. For each patient, the lower ABI from both legs was used for further evaluation. Fifteen patients (1.8%) with ABI >1.5 were excluded. We compared patients with ABI <0.9 according to the current definition (with PAD, n=204 [25.0%]), those with ABI >or=0.9 according to the modified definition (without PAD, n=524 [64.2%]), and those with ABI <0.9 according to the modified definition and >or=0.9 according to the current definition (suspected PAD, n=88 [10.8%]). Follow-up data (median 6.6 years) were available for 812 patients (99.5%); 157 patients (19.3%) experienced cardiovascular events (cardiovascular death, myocardial infarction, or stroke). Patients without PAD had the lowest cardiovascular event rate, whereas event rates were comparable for patients with PAD and those with suspected PAD (14.8% versus 28.4% versus 25.0%, respectively). In a fully adjusted Cox regression analysis that included patients without PAD as the reference group, the hazard ratio (95% CI) was 1.56 (0.97 to 2.53) for patients with suspected PAD and 1.67 (1.16 to 2.40) for patients with PAD. CONCLUSIONS: When the higher ankle pressure is used for ABI calculation, a group of patients at high risk for cardiovascular events is overlooked. With a simple modification of ABI (use of the lower instead of the higher ankle pressure), more patients at risk could be identified. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/18697822/Different_calculations_of_ankle_brachial_index_and_their_impact_on_cardiovascular_risk_prediction_ L2 - https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.107.763227?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -