 |
 |

The Long-term Prognostic Value of the Resting and Postexercise Ankle-Brachial Index
Harm H. H. Feringa, MD;
Jeroen J. J. Bax, MD, PhD;
Virginie H. van Waning, MD;
Eric Boersma, PhD;
Abdou Elhendy, MD, PhD;
Olaf Schouten, MD;
Marco J. Tangelder, MD, PhD;
Marc H. R. M. van Sambeek, MD, PhD;
Anton H. van den Meiracker, MD, PhD;
Don Poldermans, MD, PhD
Arch Intern Med. 2006;166:529-535.
Background Peripheral arterial disease is associated with a high incidence of cardiovascular mortality. Peripheral arterial disease can be detected by using the ankle-brachial index (ABI). This study assessed the prognostic value of the postexercise ABI in addition to the resting ABI on long-term mortality in patients with suspected peripheral arterial disease.
Methods In this prospective cohort study of 3209 patients (mean ± SD age, 63 ± 12 years; 71.1% male), resting and postexercise ABI values were measured and a reduction of postexercise ABI over baseline resting readings was calculated. The mean follow-up was 8 years (interquartile range, 4-11 years).
Results During follow-up, 1321 patients (41.2%) died. After adjusting for clinical risk factors, lower resting ABI values (hazard ratio per 0.10 lower ABI, 1.08; 95% confidence interval [CI], 1.06-1.10), lower postexercise ABI values (hazard ratio per 0.10 lower ABI, 1.09; 95% CI, 1.08-1.11), and higher reductions of ABI values over baseline readings (hazard ratio per 10% lower ABI, 1.12; 95% CI, 1.09-1.14) were significantly associated with a higher incidence of mortality. In patients with a normal resting ABI (n =789), a reduction of the postexercise ABI by 6% to 24%, 25% to 55%, and greater than 55% was associated with a 1.6-fold (95% CI, 1.2-2.2), 3.5-fold (95% CI, 2.4-5.0), and 4.8-fold (95% CI, 2.5-9.1) increased risk of mortality, respectively.
Conclusions Resting and postexercise ABI values are strong and independent predictors of mortality. A reduction of postexercise ABI over baseline readings can identify additional patients (who have normal ABI values at rest) at increased risk of subsequent mortality.
Author Affiliations: Departments of Anesthesiology (Drs Feringa, van Waning, and Poldermans), Cardiology (Dr Boersma), Vascular Surgery (Drs Schouten, Tangelder, and van Sambeek), and Internal Medicine (Dr van den Meiracker), Erasmus Medical Centre, Rotterdam, the Netherlands; Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands (Dr Bax); and Department of Internal Medicine, Section of Cardiology, University of Nebraska, Omaha (Dr Elhendy).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Tibial Artery Calcification as a Marker of Amputation Risk in Patients With Peripheral Arterial Disease
Guzman et al.
J Am Coll Cardiol 2008;51:1967-1974.
ABSTRACT
| FULL TEXT
Update in General Internal Medicine
Harrington and Munekata
ANN INTERN MED 2007;147:104-116.
FULL TEXT
2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)
Authors/Task Force Members: et al.
Eur Heart J 2007;0:ehm236v1-75.
FULL TEXT
Reproducibility and reliability of the ankle--brachial index as assessed by vascular experts, family physicians and nurses
Holland-Letz et al.
Vasc Med 2007;12:105-112.
ABSTRACT
|