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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).

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