title: Prognostic value of an abnormal ankle-brachial index in patients receiving drug-eluting stents.
abstract: Advanced atherosclerotic disease increases the risk of stent thrombosis after drug-eluting stent (DES) implantation. We aimed to determine if an abnormal ankle-brachial index (ABI) value as a surrogate of atherosclerotic disease and vascular inflammation provides information on 1-year risk of cardiovascular events after DES implantation. A prospective cohort of 1,437 consecutive patients undergoing DES implantation from January through April 2008 in 26 Spanish hospitals was examined. ABI was calculated by Doppler in a standardized manner. Patients were followed to 12 months after the percutaneous coronary intervention to determine total and cardiovascular mortality, stroke, nonfatal acute coronary syndrome (ACS), and new revascularizations. Association of an abnormal ABI value (i.e., ≤ 0.9 or ≥ 1.4) with outcomes was assessed by conventional logistic regression and by propensity-score analysis. Patients with abnormal ABI values (n = 582, 40.5%) in general had higher global cardiovascular risk, the reason for DES implantation was more often ACS, and had a higher rate of complications during admission (heart failure or stroke or major hemorrhage 11.3% vs 5.3%, p <0.001). An abnormal ABI value was independently associated with 1-year total mortality (odds ratio 2.23, 95% confidence interval 1.13 to 4.4) and cardiovascular mortality (odds ratio 2.06, 95% confidence interval 1.04 to 4.22). No independent association was found between an abnormal ABI value and 1-year nonfatal ACS, stroke, and new revascularizations. In conclusion, although an abnormal ABI value was associated with fatal outcomes in patients receiving DESs, no association was found with nonfatal ACS and new revascularizations. A clear relation between abnormal ABI and surrogates of DES thrombosis could not be established.
authors.affiliation: Epidemiology Unit, Cardiology Department, Hospital Vall d'Hebron, CIBER de Epidemiología y Salud Pública, Red de Enfermedades Cardiovasculares (RECAVA), Barcelona, Spain.
authors.forename: Aida
authors.initials: A
authors.lastname: Ribera
authors.forename: Ignacio
authors.initials: I
authors.lastname: Ferreira-González
authors.forename: Josep Ramón
authors.initials: JR
authors.lastname: Marsal
authors.forename: Purificación
authors.initials: P
authors.lastname: Cascant
authors.forename: Gaietà
authors.initials: G
authors.lastname: Permanyer-Miralda
authors.forename: Omar
authors.initials: O
authors.lastname: Abdul-Jawad
authors.forename: Luis Antonio
authors.initials: LA
authors.lastname: Iñigo-Garcia
authors.forename: Jordi
authors.initials: J
authors.lastname: Guarinos-Oltra
authors.forename: Angel
authors.initials: A
authors.lastname: Cequier
authors.forename: Leire
authors.initials: L
authors.lastname: Goicolea-Güemez
authors.forename: Bruno
authors.initials: B
authors.lastname: García-Del-Blanco
authors.forename: Gerard
authors.initials: G
authors.lastname: Martí
authors.forename: David
authors.initials: D
authors.lastname: García-Dorado
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000628:therapy; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D055109:Ankle Brachial Index; D001916:Brachial Artery / Q000000981:diagnostic imaging; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000401:mortality* / Q000628:therapy*; D003328:Coronary Thrombosis / Q000517:prevention & control; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D019233:Retreatment; D020521:Stroke / Q000453:epidemiology; D018608:Ultrasonography, Doppler