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Screening of unrecognized peripheral arterial disease (PAD) using ankle-brachial index in high cardiovascular risk patients free from symptomatic PAD.
J Vasc Surg. 2009 Sep; 50(3):572-80.JV

Abstract

OBJECTIVE

To determine the utility of ankle-brachial index (ABI) in screening for unrecognized peripheral arterial disease (PAD). Although PAD is a consistent predictor of cardiovascular morbidity and mortality, it is often under-diagnosed and under-treated.

METHODS

In this prospective, observational, real-life, epidemiologic study (ELLIPSE) the prevalence of PAD (ABI < 0.9) was calculated in 2146 asymptomatic patients > or =55 years of age who were at high cardiovascular risk and who were hospitalized in departments of cardiology, diabetology, geriatrics, internal medicine, or neurology in metropolitan France. Univariate and multivariate analyses were performed to identify PAD risk factors. The discriminatory power of the model was evaluated by calculating the area under the curve (AUC) of the receiver operating characteristic curve.

RESULTS

The ABI was <0.9 in 41.1% of patients. In the multivariate analysis, absence of > or =1 pulse (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.81 to 2.63; P < .0001), arterial bruit (OR, 1.92; 95%CI, 1.34 to 2.75; P < .0004), previous non-Q-wave myocardial infarction (OR, 1.50; 95%CI, 1.08 to 2.08; P = .02), regular smoking (OR, 1.49; 95%CI, 1.22 to 1.80; P < .0001), age > or =81 years (OR, 1.45; 95%CI, 1.15 to 1.82; P = .001), creatinine clearance <60 mL/min (OR, 1.33; 95%CI, 1.08 to 1.63; P = .008), and treated hypertension (OR, 1.28; 95%CI, 1.03 to 1.59; P = .03) were significantly associated with PAD. Although risk increased with the number of variables, the model, based on clinical symptoms and on medical history parameters, was not discriminatory (AUC = 0.66). On average, physicians took 15 minutes to perform the ABI test.

CONCLUSIONS

The high prevalence of asymptomatic PAD in this patient population suggests that ABI should systematically be performed in high-risk hospitalized patients to ensure that appropriate secondary prevention programs are initiated.

Authors+Show Affiliations

Department of Internal Medicine, Avicenne University Hospital - AP-HP and Paris 13 University, Bobigny, France. jean-jacques.mourad@avc.aphp.frNo 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)

Evaluation Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19560312

Citation

Mourad, Jean-Jacques, et al. "Screening of Unrecognized Peripheral Arterial Disease (PAD) Using Ankle-brachial Index in High Cardiovascular Risk Patients Free From Symptomatic PAD." Journal of Vascular Surgery, vol. 50, no. 3, 2009, pp. 572-80.
Mourad JJ, Cacoub P, Collet JP, et al. Screening of unrecognized peripheral arterial disease (PAD) using ankle-brachial index in high cardiovascular risk patients free from symptomatic PAD. J Vasc Surg. 2009;50(3):572-80.
Mourad, J. J., Cacoub, P., Collet, J. P., Becker, F., Pinel, J. F., Huet, D., Sevestre-Pietri, M. A., & Priollet, P. (2009). Screening of unrecognized peripheral arterial disease (PAD) using ankle-brachial index in high cardiovascular risk patients free from symptomatic PAD. Journal of Vascular Surgery, 50(3), 572-80. https://doi.org/10.1016/j.jvs.2009.04.055
Mourad JJ, et al. Screening of Unrecognized Peripheral Arterial Disease (PAD) Using Ankle-brachial Index in High Cardiovascular Risk Patients Free From Symptomatic PAD. J Vasc Surg. 2009;50(3):572-80. PubMed PMID: 19560312.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Screening of unrecognized peripheral arterial disease (PAD) using ankle-brachial index in high cardiovascular risk patients free from symptomatic PAD. AU - Mourad,Jean-Jacques, AU - Cacoub,Patrice, AU - Collet,Jean-Philippe, AU - Becker,François, AU - Pinel,Jean-François, AU - Huet,Dominique, AU - Sevestre-Pietri,Marie-Antoinette, AU - Priollet,Pascal, AU - ,, Y1 - 2009/06/27/ PY - 2009/02/25/received PY - 2009/04/21/revised PY - 2009/04/21/accepted PY - 2009/6/30/entrez PY - 2009/6/30/pubmed PY - 2009/9/16/medline SP - 572 EP - 80 JF - Journal of vascular surgery JO - J Vasc Surg VL - 50 IS - 3 N2 - OBJECTIVE: To determine the utility of ankle-brachial index (ABI) in screening for unrecognized peripheral arterial disease (PAD). Although PAD is a consistent predictor of cardiovascular morbidity and mortality, it is often under-diagnosed and under-treated. METHODS: In this prospective, observational, real-life, epidemiologic study (ELLIPSE) the prevalence of PAD (ABI < 0.9) was calculated in 2146 asymptomatic patients > or =55 years of age who were at high cardiovascular risk and who were hospitalized in departments of cardiology, diabetology, geriatrics, internal medicine, or neurology in metropolitan France. Univariate and multivariate analyses were performed to identify PAD risk factors. The discriminatory power of the model was evaluated by calculating the area under the curve (AUC) of the receiver operating characteristic curve. RESULTS: The ABI was <0.9 in 41.1% of patients. In the multivariate analysis, absence of > or =1 pulse (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.81 to 2.63; P < .0001), arterial bruit (OR, 1.92; 95%CI, 1.34 to 2.75; P < .0004), previous non-Q-wave myocardial infarction (OR, 1.50; 95%CI, 1.08 to 2.08; P = .02), regular smoking (OR, 1.49; 95%CI, 1.22 to 1.80; P < .0001), age > or =81 years (OR, 1.45; 95%CI, 1.15 to 1.82; P = .001), creatinine clearance <60 mL/min (OR, 1.33; 95%CI, 1.08 to 1.63; P = .008), and treated hypertension (OR, 1.28; 95%CI, 1.03 to 1.59; P = .03) were significantly associated with PAD. Although risk increased with the number of variables, the model, based on clinical symptoms and on medical history parameters, was not discriminatory (AUC = 0.66). On average, physicians took 15 minutes to perform the ABI test. CONCLUSIONS: The high prevalence of asymptomatic PAD in this patient population suggests that ABI should systematically be performed in high-risk hospitalized patients to ensure that appropriate secondary prevention programs are initiated. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/19560312/Screening_of_unrecognized_peripheral_arterial_disease__PAD__using_ankle_brachial_index_in_high_cardiovascular_risk_patients_free_from_symptomatic_PAD_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(09)00986-0 DB - PRIME DP - Unbound Medicine ER -