Ankle-brachial index as a predictor of coronary disease events in elderly patients submitted to coronary angiography.
OBJECTIVE
To correlate the importance of the ankle-brachial index in terms of cardiovascular morbimortality and the extent of coronary arterial disease amongst elderly patients without clinical manifestations of lower limb peripheral arterial disease.


METHODS
We analyzed prospective data from 100 patients over 65 years of age with coronary arterial disease, as confirmed by coronary angiography, and with over 70% stenosis of at least one sub-epicardial coronary artery. We measured the ankle-brachial index immediately after coronary angiography, and a value of <0.9 was used to diagnose peripheral arterial disease.


RESULTS
The patients' average age was 77.4 years. The most prevalent risk factor was hypertension (96%), and the median late follow-up appointment was 28.9 months. The ankle-brachial index was <0.9 in 47% of the patients, and a low index was more prevalent in patients with multiarterial coronary disease compared to patients with uniarterial disease in the same group. Using a bivariate analysis, only an ankle-brachial index of <0.9 was a strong predictive factor for cardiovascular events, thereby increasing all-cause deaths and fatal and non-fatal acute myocardial infarctions two- to three-fold.


CONCLUSIONS
In elderly patients with documented coronary disease, a low ankle-brachial index (<0.9) was associated with the severity and extent of coronary arterial disease, and in late follow-up appointments, a low index was correlated with an increase in the occurrence of major cardiovascular events.
Departamento de Cardiologia, Universidade Federal do Estado de São Paulo, São PauloSP, Brazil.
Eduardo D E
ED
Papa
Departamento de Cardiologia, Universidade Federal do Estado de São Paulo, São PauloSP, Brazil.
Izo
I
Helber
Departamento de Cardiologia, Hospital Israelita Albert Einstein, São PauloSP, Brazil.
Manes R
MR
Ehrlichmann
Departamento de Cardiologia, Universidade Federal do Estado de São Paulo, São PauloSP, Brazil.
Claudia Maria Rodrigues
CM
Alves
Departamento de Cardiologia, Hospital Israelita Albert Einstein, São PauloSP, Brazil.
Marcia
M
Makdisse
Departamento de Cardiologia, Universidade Federal do Estado de São Paulo, São PauloSP, Brazil.
Livia N
LN
Matos
Departamento de Cardiologia, Universidade Federal do Estado de São Paulo, São PauloSP, Brazil.
Jairo Lins
JL
Borges
Department of Medicine, Duke University School of Medicine, DurhamNorth Carolina, USA.
Renato D
RD
Lopes
Departamento de Cardiologia, Universidade Federal do Estado de São Paulo, São PauloSP, Brazil.
Edson
E
Stefanini
Departamento de Cardiologia, Universidade Federal do Estado de São Paulo, São PauloSP, Brazil.
Antonio Carlos
AC
Carvalho
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013997:Time Factors