Prognostic value of the ankle-brachial index in elderly patients with a stable chronic cardiovascular event.
OBJECTIVE
Patients with polyvascular arterial disease have a greater risk of suffering a new atherothrombotic episode than those with involvement of only one vascular territory. We have studied the predictive prognostic value of the detection of non-diagnosed peripheral arterial disease, determined by measuring the ankle-brachial index in a population of elderly patients with stable chronic cardiac or cerebrovascular disease.


METHODS
This was a multicenter, prospective cohort study with consecutive inclusion of patients between 65 and 85 years of age with a previous atherothrombotic event, but without previously established peripheral arterial disease.


RESULTS
A total of 1096 patients were evaluated during 11.7 (+ or - 2.2) months of follow-up. An ankle-brachial index of < 0.9 was observed in 29.9% and > 1.4 in 6.9%. The detection of an ankle-brachial index < 0.9 was clearly associated with the presence of a combined primary event of cardiovascular death and non-fatal cardiovascular event [HR 1.99 (95% CI, 1.49-2.66; P < 0.001)]. There was also a significant relationship between ankle-brachial index > 1.4 and total (P = 0.001) or cardiovascular (P = 0.020) deaths. The predictive value of both ranges of the ankle-brachial index was maintained after adjusting for age, sex, diabetes mellitus, vascular territory, macroalbuminuria or glomerular filtration rate.


CONCLUSIONS
The detection of non-diagnosed peripheral arterial disease in patients with stable coronary or cerebrovascular events identifies a very high risk population that might benefit from more intensive treatment.
Heart Failure and Vascular Risk Unit, Internal Medicine Department, Hospital Ramón y Cajal, Universidad de Alcalá, Madrid, Spain. luis.manzano@uah.es
L
L
Manzano
J M
JM
Mostaza
C
C
Suarez
F J
FJ
Del Valle
J A
JA
Ortiz
J L
JL
Sampedro
A
A
Pose
P
P
Roman
P
P
Vieitez
M A
MA
Sánchez-Zamorano
D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D002318:Cardiovascular Diseases / Q000503:physiopathology*; D002908:Chronic Disease; D006801:Humans; D011379:Prognosis; D011446:Prospective Studies