Usefulness of an abnormal ankle-brachial index for detecting multivessel coronary disease in patients with acute coronary syndrome.
OBJECTIVE
The presence of peripheral arterial disease in patients with coronary artery disease is associated with a poor cardiovascular outcome. However, the majority of affected patients are asymptomatic and the condition is underdiagnosed. The ankle-brachial index (ABI) provides a simple method of diagnosis. The aim of this study was to assess the usefulness of an abnormal ABI for identifying multivessel coronary artery disease in patients with acute coronary syndrome (ACS).


METHODS
We analyzed data on all ACS patients included in the PAMISCA multicenter study (with 94 participating hospitals) who underwent catheterization during admission. Patients were diagnosed with multivessel coronary disease if two or more major epicardial vessels or the left main coronary artery, or both, were affected. An ABI <or=0.9 or >1.4 was considered abnormal.


RESULTS
The study included 1031 patients with a mean age of 67.7 years. Of these, 542 had multivessel disease (52.6%). Compare with those without multivessel disease, these patients were older (66.6 years vs. 62.6 years; P< .001), had higher prevalences of hypertension (65.9% vs. 56.2%; P< .005), diabetes mellitus (40.6% vs. 26.0%; P< .001) and hypercholesterolemia (89.1% vs. 80.4%; P< .001), and were more likely to have a history of cardiovascular disease (30.1% vs. 13.9%; P< .001) or an abnormal ABI (45.4% vs. 30.3%; P< .001). Multivariate analysis showed that the presence of an abnormal ABI was associated with an increased risk of multivessel disease (odds ratio=1.58; 95% confidence interval, 1.16-2.15; P< .05).


CONCLUSIONS
In patients with ACS, an abnormal ABI was independently associated with the risk of multivessel coronary artery disease.
Núñez
Daniel
D
Servicio de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain.
Morillas
Pedro
P
Quiles
Juan
J
Cordero
Alberto
A
Guindo
Josep
J
Soria
Federico
F
Mazón
Pilar
P
Lekuona
Iñaki
I
Rodríguez-Padial
Luis
L
Llácer
Angel
A
González-Juanatey
José Ramón
JR
Bertomeu
Vicente
V
D054058:Acute Coronary Syndrome / Q000150:complications*; D000368:Aged; D055109:Ankle Brachial Index; D003327:Coronary Disease / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged