title: Combination of ankle brachial index and diabetes mellitus to predict cardiovascular events and mortality after an acute coronary syndrome.
abstract: OBJECTIVE
  Diabetes mellitus and low ankle brachial index (ABI) are both conditions associated with an increased cardiovascular risk. In the setting of an acute coronary syndrome (ACS), diabetes is associated with increased mortality, but little is known regarding a low ABI. The aim of the study was to evaluate the prevalence of diabetes and low ABI in patients after an ACS and their prognostic value.
  
  
  METHODS
  1156 patients ≥40 years admitted with an ACS were screened with ABI previous to hospital discharge to investigate the presence of peripheral arterial disease (PAD) (ABI value≤0.9). 1054 were finally followed for one year. Patients were stratified according to diabetes and PAD status. The primary endpoint of the study was all-cause mortality.
  
  
  RESULTS
  The prevalence of diabetes was 36% and PAD was 39.9%. After a median follow up of 382 days, 59 patients died (5.6%), the majority from a cardiovascular event. In both diabetic and nondiabetic patients, the presence of PAD was significantly associated with an increased incidence of the primary event. After adjustment for several prognostic variables, patients with diabetes and PAD had an increased risk of mortality (HR 4.05 (95% CI 1.86-8.83)). PAD and diabetic patients had an intermediate and similar incidence of cardiovascular events.
  
  
  CONCLUSIONS
  Our results show that the presence of an ABI≤0.9 predicts cardiovascular risk to the same extent as diabetes, and the combination of diabetes and PAD is a powerful tool after an ACS to predict the occurrence of an adverse event.
authors.affiliation: Hospital Universitario de San Juan, Alicante, Spain. juanquiles@secardiologia.es
authors.forename: Juan
authors.initials: J
authors.lastname: Quiles
authors.forename: Pedro
authors.initials: P
authors.lastname: Morillas
authors.forename: Vicente
authors.initials: V
authors.lastname: Bertomeu
authors.forename: Pilar
authors.initials: P
authors.lastname: Mazon
authors.forename: Alberto
authors.initials: A
authors.lastname: Cordero
authors.forename: Federico
authors.initials: F
authors.lastname: Soria
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Facila
authors.forename: Jose Ramon
authors.initials: JR
authors.lastname: Gonzalez-Juanatey
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality*; D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index / Q000706:statistics & numerical data*; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000401:mortality*; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors