title: Relation between the ankle-brachial index and the complexity of coronary artery disease in older patients.
abstract: BACKGROUND
  In the elderly, the ankle-brachial index (ABI) has greater than 90% sensitivity and specificity for peripheral artery disease identification. A well-known relation exists between peripheral artery disease and the number of diseased coronary vessels. Yet, other anatomical characteristics have important impacts on the type of treatment and prognosis.
  
  
  OBJECTIVE
  To determine the relation between ABI and the complexity of coronary artery disease, by different anatomical classifications.
  
  
  METHODS
  This study was a prospective analysis of patients ≥65 years old who were undergoing elective coronary angiography for ischemic coronary disease. The ABI was calculated for each leg, as the ratio between the lowest ankle pressure and the highest brachial pressure. The analysis of coronary anatomy was performed by three interventional cardiologists; it included classification of each lesion with >50% diameter stenosis, according to the American Heart Association criteria, and calculation of the SYNTAX score.
  
  
  RESULTS
  The study recruited 204 consecutive patients (median age: 72.5 years). Stable angina was present in 51% of patients. Although only 1% of patients reported peripheral artery disease, 45% exhibited an abnormal ABI. The number of lesions per patient, the number of patients with complex lesions, and the median SYNTAX scores were greater in the group with abnormal ABI. However, among 144 patients with obstructive coronary artery disease, despite abnormal ABI being able to identify a higher rate of patients with B2 or C type lesions (70.9% versus 53.8%; P=0.039), the mean SYNTAX scores (13 versus 9; P=0.14), and the proportion of patients with SYNTAX score >16 (34.2% versus 27.7%; P=0.47), were similar, irrespective of ABI.
  
  
  CONCLUSIONS
  In patients ≥65 years old the presence of peripheral artery disease could discriminate a group of patients with greater occurrence of B2 and C type lesions, but similar median SYNTAX score.
authors: Department of Interventional Cardiology, Federal University of São Paulo, São Paulo, Brazil.
authors: Felipe José de Andrade
authors: FJ
authors: Falcão
authors: Cláudia Maria
authors: CM
authors: Rodrigues Alves
authors: Adriano
authors: A
authors: Caixeta
authors: Leonardo
authors: L
authors: de Freitas Guimarães
authors: Juscélio Trajano
authors: JT
authors: de Sousa Filho
authors: Juliana A
authors: JA
authors: Soares
authors: Izo
authors: I
authors: Helber
authors: Antônio C
authors: AC
authors: Carvalho
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D001938:Brazil; D016001:Confidence Intervals; D003324:Coronary Artery Disease / Q000503:physiopathology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000175:diagnosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity
keywords: ankle-brachial index; coronary artery disease; elderly health; peripheral artery disease