title: Low ankle-brachial index predicts early risk of recurrent stroke in patients with acute cerebral ischemia.
abstract: OBJECTIVE
  Low ankle-brachial blood pressure index (ABI) identifies patients with symptomatic and asymptomatic peripheral arterial disease (PAD). We sought to investigate the association of low ABI with early risk of stroke recurrence in patients with acute cerebral ischemia (ACI) and without history of symptomatic PAD.
  
  
  METHODS
  Consecutive patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) and no previous history of PAD were prospectively evaluated with ABI measurements. Demographic characteristics, vascular risk factors and secondary prevention therapies were documented. An ABI ≤0.90 in either leg was considered as evidence of asymptomatic PAD, and an ABI >0.90 was considered as normal. Patients with elevated ABI (>1.30) were excluded. The outcome of interest was recurrent stroke during 30-day follow-up.
  
  
  RESULTS
  A total of 176 patients with acute cerebral ischemia (mean age 64±14 years, 59.1% men, 76.7% AIS) were evaluated. Asymptomatic PAD was detected in 14.8% (95%CI: 10.2-20.8%) of the studied population. The following factors were independently associated with low ABI on multivariate logistic regression models, after adjustment for potential confounders: coronary artery disease (p=0.008), diabetes mellitus (p=0.017) and increasing age (p=0.042). The cumulative 30-day recurrence rate was higher in patients with low ABI (19.2%; 95%CI: 4.1-34.3) compared to the rest (3.3%; 95%CI: 0.4-6.2%; p=0.001). Atherothrombotic stroke (ASCO grade I; p<0.001), increasing age (p=0.002) and low ABI (p=0.004) were independent predictors of stroke recurrence on multivariate Cox regression models adjusting for confounders.
  
  
  CONCLUSIONS
  Low ABI appears to be associated with a higher risk of early recurrent stroke in patients with ACI and no history of symptomatic PAD.
authors.affiliation: Department of Neurology, Democritus University of Thrace, School of Medicine, Alexandroupolis, Greece. tsivgoulisgiorg@yahoo.gr
authors.forename: Georgios
authors.initials: G
authors.lastname: Tsivgoulis
authors.forename: Chrysi
authors.initials: C
authors.lastname: Bogiatzi
authors.forename: Ioannis
authors.initials: I
authors.lastname: Heliopoulos
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Vadikolias
authors.forename: Eleni
authors.initials: E
authors.lastname: Boutati
authors.forename: Soultana
authors.initials: S
authors.lastname: Tsakaldimi
authors.forename: Omar S
authors.initials: OS
authors.lastname: Al-Attas
authors.forename: Paris
authors.initials: P
authors.lastname: Charalampidis
authors.forename: Charitomeni
authors.initials: C
authors.lastname: Piperidou
authors.forename: Efstratios
authors.initials: E
authors.lastname: Maltezos
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Papanas
mesh_terms: D000208:Acute Disease; D000368:Aged; D055109:Ankle Brachial Index; D058070:Asymptomatic Diseases; D002545:Brain Ischemia / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D016009:Chi-Square Distribution; D005260:Female; D006115:Greece; D006760:Hospitalization; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D018608:Ultrasonography, Doppler