title: Noncompressible arteries correlate with increased cardiovascular mortality at 2 years.
abstract: BACKGROUND
  The ankle-brachial index (ABI) is a useful screening tool for the detection of peripheral vascular disease (PVD). Using ABI measurements, patients can be stratified into different severities of arterial occlusive disease.
  
  
  METHODS
  Four hundred forty-four Veterans Health Administration Medical Center patients were referred for PVD between 2004 and 2005. Of those, 231 patients had an ABI ≤0.90 or >1.2 with known treatment and follow-up obtained from electronic medical records. These individuals had bilateral ABI measurements and were observed for a median of 23 months (range, 4.0-60.0 months). Patients were divided into 4 ABI categories: severe (ABI ≤0.30; n = 62), moderate (ABI 0.30-≤0.60; n = 138), mild (ABI 0.60-≤0.90; n = 89), normal (ABI 0.90-≤1.2; n = 86), and noncompressible (ABI >1.2; n = 69).
  
  
  RESULTS
  Mortality from cardiovascular disease in the severe, moderate, mild, normal, and noncompressible groups was 4.8%, 8.0%, 10.1%, 0%, and 21.7%, respectively, at the mean follow-up of 2 years. For all-cause mortality, the overall percent for each group respectively was 32.3%, 31.9%, 31.5%, 14%, and 42% (P = 0.003). To our surprise, ABIs <0.9 did not show a linear correlation with 2-year survival. However, an ABI >1.2, indicating noncompressible arteries, correlated significantly with higher rates of mortality at a mean follow-up of 2 years (33.3%). Cardiovascular disease and amputation were also significantly higher in those with noncompressible arteries than in the other groups.
  
  
  CONCLUSIONS
  ABI is a noninvasive, inexpensive test that provides valuable information on a patient's risk of death. We recommend that patients with noncompressible vessels undergo systemic cardiovascular work-up, including coronary and carotid artery evaluation.
authors.affiliation: Department of Vascular Surgery, University of California-Irvine, School of Medicine, Orange, CA 92868, USA.
authors.forename: Arya
authors.initials: A
authors.lastname: Amini
authors.forename: Ian
authors.initials: I
authors.lastname: Gordon
authors.forename: Samuel
authors.initials: S
authors.lastname: Wilson
authors.forename: Russell A
authors.initials: RA
authors.lastname: Williams
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D055109:Ankle Brachial Index; D002140:California / Q000453:epidemiology; D002423:Cause of Death; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D059289:Vascular Stiffness; D058014:Veterans Health