title: Usefulness of an abnormal ankle-brachial index for detecting multivessel coronary disease in patients with acute coronary syndrome.
abstract: 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.
authors.affiliation: Servicio de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Núñez
authors.forename: Pedro
authors.initials: P
authors.lastname: Morillas
authors.forename: Juan
authors.initials: J
authors.lastname: Quiles
authors.forename: Alberto
authors.initials: A
authors.lastname: Cordero
authors.forename: Josep
authors.initials: J
authors.lastname: Guindo
authors.forename: Federico
authors.initials: F
authors.lastname: Soria
authors.forename: Pilar
authors.initials: P
authors.lastname: Mazón
authors.forename: Iñaki
authors.initials: I
authors.lastname: Lekuona
authors.forename: Luis
authors.initials: L
authors.lastname: Rodríguez-Padial
authors.forename: Angel
authors.initials: A
authors.lastname: Llácer
authors.forename: José Ramón
authors.initials: JR
authors.lastname: González-Juanatey
authors.forename: Vicente
authors.initials: V
authors.lastname: Bertomeu
mesh_terms: 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