Association of low ankle-brachial index with mortality in patients with ischemic heart disease.
OBJECTIVE
Whether a low ankle-brachial index can improve the prediction of all-cause and cardiovascular mortality on top of conventional risk factors remains unclear among patients with ischemic heart disease. The present study aimed to assess the association between the ankle-brachial index and mortality in Chinese patients.


METHODS
This was an observational prospective study and 1,800 Chinese patients aged > or =35 years were followed-up from 2004 to 2007-2008.


RESULTS
There were 280 deaths, of which 165 were attributable to cardiovascular disease. Compared with patients with an ankle-brachial index > or =1.1, the risk of mortality increased linearly in lower ankle-brachial index categories: patients with an ankle-brachial index of 0.9 to 1.1, 0.7 to 0.9, <0.7 had hazard ratios of 1.60, 2.07, and 3.08 for all-cause mortality and 1.89, 2.33, and 4.09 for cardiovascular mortality (p for trend <0.001), respectively. Addition of the ankle-brachial index significantly (p<0.001) increased the predictive value of the model for 3-year deaths compared with a model including risk factors alone. Comparison of areas under receiver operator characteristics curves confirmed that a model including the ankle-brachial index discriminated better than without.


CONCLUSIONS
There was an inverse association between the ankle-brachial index and mortality. Addition of the ankle-brachial index significantly improved the prediction of 3-year mortality over and above that of conventional risk factors. We recommend that the ankle-brachial index be incorporated into prognostic assessment for patients with ischemic heart disease.
Department of Cardiology, Shengjing Hospital of China Medical University, 155 Nanjing North Street, Heping, Shenyang, China. liqiangzhang@126.com
Liqiang
L
Zheng
Jue
J
Li
Dayi
D
Hu
Yingyi
Y
Luo
Xiankai
X
Li
Yuanxi
Y
Xu
Zhaoqing
Z
Sun
Yingxian
Y
Sun
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index / Q000401:mortality*; D019540:Area Under Curve; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000401:mortality*; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors