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PAD as a risk factor for mortality among patients with elevated ABI--a clinical study.
Eur J Vasc Endovasc Surg 2010; 39(3):316-22EJ

Abstract

OBJECTIVE

This study aims to evaluate mortality across ankle-brachial index (ABI) values and to assess the association between elevated ABI, peripheral arterial disease (PAD) and mortality.

DESIGN

This is a retrospective clinical study.

MATERIAL AND METHODS

A total of 2159 patients referred with a suspicion of PAD had their ABI and toe brachial index (TBI) measured by photoplethysmography. ABI > or =1.3 was considered falsely elevated while TBI <0.60 was the diagnostic criterion for PAD among the subjects. The cohort was followed up for total and cardiovascular mortality until 30 June 2008, by record linkage with the National Causes-of-Death Register.

RESULTS

The average follow-up time was 39 months. A total of 576 (26.7%) patients died during the follow-up. Mortality was highest in the elevated ABI group (35.7% for elevated ABI; 30.1% for low ABI and 16.0% for normal ABI, p < 0.001). There was a greater than twofold risk of total, and an increased but statistically non-significant risk of, cardiovascular mortality among patients with elevated ABI. Similar risk ratios were noted for the low ABI (< or =0.9) group. More pronounced associations were observed at both ends of the scale when ABI was divided into sub-categories. The overall survival was significantly worse for the elevated ABI group than for both the normal and the low-ABI group (p < 0.01 and p = 0.013, respectively). PAD was found to be independently associated with both total and cardiovascular mortality among those with elevated ABI (odds ratio (OR): 2.21; 95% confidence interval (CI): 1.01-4.85 and OR: 4.90; 95% CI: 1.50-16.04, respectively).

CONCLUSIONS

The association between elevated ABI and poor survival is similar to that of low ABI. PAD appears to be an independent risk factor for mortality among patients with elevated ABI.

Authors+Show Affiliations

Department of Surgery, Division of Vascular Surgery, Tampere University Hospital, P.O. Box 2000, 33521 Tampere, Finland. velipekka.suominen@pshp.fiNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

20089422

Citation

Suominen, V, et al. "PAD as a Risk Factor for Mortality Among Patients With Elevated ABI--a Clinical Study." European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery, vol. 39, no. 3, 2010, pp. 316-22.
Suominen V, Uurto I, Saarinen J, et al. PAD as a risk factor for mortality among patients with elevated ABI--a clinical study. Eur J Vasc Endovasc Surg. 2010;39(3):316-22.
Suominen, V., Uurto, I., Saarinen, J., Venermo, M., & Salenius, J. (2010). PAD as a risk factor for mortality among patients with elevated ABI--a clinical study. European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery, 39(3), pp. 316-22. doi:10.1016/j.ejvs.2009.12.003.
Suominen V, et al. PAD as a Risk Factor for Mortality Among Patients With Elevated ABI--a Clinical Study. Eur J Vasc Endovasc Surg. 2010;39(3):316-22. PubMed PMID: 20089422.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - PAD as a risk factor for mortality among patients with elevated ABI--a clinical study. AU - Suominen,V, AU - Uurto,I, AU - Saarinen,J, AU - Venermo,M, AU - Salenius,J, Y1 - 2010/01/20/ PY - 2009/09/23/received PY - 2009/12/03/accepted PY - 2010/1/22/entrez PY - 2010/1/22/pubmed PY - 2010/4/2/medline SP - 316 EP - 22 JF - European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery JO - Eur J Vasc Endovasc Surg VL - 39 IS - 3 N2 - OBJECTIVE: This study aims to evaluate mortality across ankle-brachial index (ABI) values and to assess the association between elevated ABI, peripheral arterial disease (PAD) and mortality. DESIGN: This is a retrospective clinical study. MATERIAL AND METHODS: A total of 2159 patients referred with a suspicion of PAD had their ABI and toe brachial index (TBI) measured by photoplethysmography. ABI > or =1.3 was considered falsely elevated while TBI <0.60 was the diagnostic criterion for PAD among the subjects. The cohort was followed up for total and cardiovascular mortality until 30 June 2008, by record linkage with the National Causes-of-Death Register. RESULTS: The average follow-up time was 39 months. A total of 576 (26.7%) patients died during the follow-up. Mortality was highest in the elevated ABI group (35.7% for elevated ABI; 30.1% for low ABI and 16.0% for normal ABI, p < 0.001). There was a greater than twofold risk of total, and an increased but statistically non-significant risk of, cardiovascular mortality among patients with elevated ABI. Similar risk ratios were noted for the low ABI (< or =0.9) group. More pronounced associations were observed at both ends of the scale when ABI was divided into sub-categories. The overall survival was significantly worse for the elevated ABI group than for both the normal and the low-ABI group (p < 0.01 and p = 0.013, respectively). PAD was found to be independently associated with both total and cardiovascular mortality among those with elevated ABI (odds ratio (OR): 2.21; 95% confidence interval (CI): 1.01-4.85 and OR: 4.90; 95% CI: 1.50-16.04, respectively). CONCLUSIONS: The association between elevated ABI and poor survival is similar to that of low ABI. PAD appears to be an independent risk factor for mortality among patients with elevated ABI. SN - 1532-2165 UR - https://www.unboundmedicine.com/medline/citation/20089422/PAD_as_a_risk_factor_for_mortality_among_patients_with_elevated_ABI__a_clinical_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1078-5884(09)00610-8 DB - PRIME DP - Unbound Medicine ER -