title: Asymptomatic low ankle-brachial index in vascular surgery patients: a predictor of perioperative myocardial damage.
abstract: OBJECTIVE
  This study evaluated the prognostic value of asymptomatic low ankle-brachial index (ABI) to predict perioperative myocardial damage, incremental to conventional cardiac risk factors imbedded in cardiac risk indices (Revised Cardiac index and Adapted Lee index).
  
  
  METHODS
  Preoperative ABI measurements were performed in 627 consecutive vascular surgery patients (carotid artery or abdominal aortic aneurysm repair). An ABI<0.90 was considered abnormal. Patients with ABI>1.40 or (a history of) intermittent claudication were excluded. Serial troponin-T measurements were performed routinely before and after surgery. The main study endpoint was perioperative myocardial damage, the composite of myocardial ischaemia and infarction. Multivariate regression analyses, adjusted for conventional risk factors, evaluated the relation between asymptomatic low ABI and perioperative myocardial damage.
  
  
  RESULTS
  In total, 148 (23%) patients had asymptomatic low ABI (mean 0.73, standard deviation+/-0.13). Perioperative myocardial damage was recorded in 107 (18%) patients. Multivariate regression analyses demonstrated that asymptomatic low ABI was associated with an increased risk of perioperative myocardial damage (odds ratio (OR): 2.4, 95% CI: 1.4-4.2) CONCLUSIONS: This study demonstrated that asymptomatic low ABI has a prognostic value to predict perioperative myocardial damage in vascular surgery patients, incremental to risk factors imbedded in conventional cardiac risk indices.
authors.affiliation: Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: W-J
authors.initials: WJ
authors.lastname: Flu
authors.forename: J-P
authors.initials: JP
authors.lastname: van Kuijk
authors.forename: M T
authors.initials: MT
authors.lastname: Voûte
authors.forename: R
authors.initials: R
authors.lastname: Kuiper
authors.forename: H J M
authors.initials: HJ
authors.lastname: Verhagen
authors.forename: J J
authors.initials: JJ
authors.lastname: Bax
authors.forename: D
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D000368:Aged; D000842:Ankle / Q000098:blood supply*; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D001916:Brachial Artery / Q000503:physiopathology*; D016893:Carotid Stenosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006331:Heart Diseases / Q000097:blood / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism / Q000473:pathology*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality
chemical_list: D015415:Biomarkers; D020107:Troponin T