title: Pathological ankle-brachial index is equivalent of advanced age in acute coronary syndromes.
abstract: BACKGROUND
  Age is one the factors associated with poor prognosis in acute coronary syndromes (ACS) and elderly patients are a high-risk collective with few parameters for mid-term cardiovascular stratification. We aimed to assess the predictive value of ankle-brachial index (ABI) in patients (> 75 years) for 1-year mortality after an ACS.
  
  
  METHODS
  Prospective, observational and multicentre study of ACS patients in whom ABI was assessed during hospitalization.
  
  
  RESULTS
  A total of 1·054 patients were included, mean age 66·6 (11·7) years from whom 26·6% were > 75 years. Elderly patients showed more history of cardiovascular disease and higher prevalence of all risk factors, except current smoking. Angiography and revascularization were performed less frequently in the elderly. Patients > 75 years showed higher presence of three vessel coronary disease and received fewer guideline-recommended treatments. Patients who died through the follow-up, mean time 387·9 ± 7·2 days, had lower ABI (0·73 ± 0·24 vs. 0·92 ± 0·22; P < 0·01), also in the elderly patients (0·73 ± 0·24 vs. 0·86 ± 0·23; P < 0·01). Cox regression analysis identified age > 75 years (HR: 2·30; IC 95% 1·26-4·18; P < 0·01) and ABI < 0·90 (HR: 3·58; IC 95% 1·80-7·15; P < 0·01) as risk factors for to 1-year mortality. Mortality was similar in elderly patients with ABI > 0·90 and young patients with ABI < 0·90; the worst prognosis was observed in elderly patients with ABI < 0·90 (HR: 10·01; 95% CI 3·74-27·15).
  
  
  CONCLUSIONS
  Elderly patients represent a relevant collective of patients with ACS and are treated less optimally. ABI predicts 1-year mortality after an ACS in elderly patients.
authors.affiliation: Hospital Universitario de San Juan, Alicante, Spain. acorderofort@gmail.com
authors.forename: Alberto
authors.initials: A
authors.lastname: Cordero
authors.forename: Pedro
authors.initials: P
authors.lastname: Morillas
authors.forename: Vicente
authors.initials: V
authors.lastname: Bertomeu-González
authors.forename: Juan
authors.initials: J
authors.lastname: Quiles
authors.forename: Federico
authors.initials: F
authors.lastname: Soria
authors.forename: Josep
authors.initials: J
authors.lastname: Guindo
authors.forename: Pilar
authors.initials: P
authors.lastname: Mazón
authors.forename: Manuel
authors.initials: M
authors.lastname: Anguita
authors.forename: Luís
authors.initials: L
authors.lastname: Rodríguez-Padial
authors.forename: José Ramón
authors.initials: JR
authors.lastname: González-Juanatey
authors.forename: Vicente
authors.initials: V
authors.lastname: Bertomeu-Martínez
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality* / Q000503:physiopathology; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D001794:Blood Pressure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index