Ankle-brachial index and cardiovascular outcomes in the Bypass Angioplasty Revascularization Investigation 2 Diabetes trial.
BACKGROUND
Peripheral arterial disease increases cardiovascular risk in many patient populations. The risks associated with an abnormal ankle-brachial index (ABI) in patients with type 2 diabetes and stable coronary artery disease have not been well described with respect to thresholds and types of cardiovascular events.


METHODS
We examined 2,368 patients in the BARI 2D trial who underwent ABI assessment at baseline. Death and major cardiovascular events (death, myocardial infarction and stroke) during follow-up (average 4.3 years) were assessed across the ABI spectrum and by categorized ABI: low (≤0.90), normal (0.91-1.3), high (>1.3), or noncompressible.


RESULTS
A total of 12,568 person-years were available for mortality analysis. During follow-up, 316 patients died, and 549 had major cardiovascular events. After adjustment for potential confounders, with normal ABI as the referent group, a low ABI conferred an increased risk of death (relative risk [RR] 1.6, CI 1.2-2.2, P = .0005) and major cardiovascular events (RR 1.4, CI 1.1-1.7, P = .004). Patients with a high ABI had similar outcomes as patients with a normal ABI, but risk again increased in patients with a noncompressible ABI with a risk of death (RR 1.9, CI 1.3-2.8, P = .001) and major cardiovascular event (RR 1.5, CI 1.1-2.1, P = .01).


CONCLUSIONS
In patients with coronary artery disease and type 2 diabetes, ABI screening and identification of ABI abnormalities including a low ABI (<1.0) or noncompressible artery provide incremental prognostic information.
Division of Cardiology, Rhode Island Hospital, Providence, RI 02903, USA. jabbott@lifespan.org
J Dawn
JD
Abbott
Manuel S
MS
Lombardero
Gregory W
GW
Barsness
Ivan
I
Pena-Sing
L Virginia
LV
Buitrón
Premranjan
P
Singh
Gail
G
Woodhead
Jean-Claude
JC
Tardif
Sheryl F
SF
Kelsey
D055109:Ankle Brachial Index; D002423:Cause of Death; D003324:Coronary Artery Disease / Q000150:complications* / Q000401:mortality*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000401:mortality*; D003925:Diabetic Angiopathies / Q000150:complications / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000401:mortality*; D011379:Prognosis; D012306:Risk; D020521:Stroke / Q000209:etiology / Q000401:mortality; D015996:Survival Rate