title: Significance of an abnormal ankle-brachial index in patients with established coronary artery disease with and without associated diabetes mellitus.
abstract: An abnormal ankle-brachial index (ABI) is associated with higher risk for future cardiovascular (CV) events; however, it is unknown whether this association is true in patients with established coronary artery disease (CAD) and associated diabetes mellitus (DM). We evaluated 679 patients with stable CAD enrolled in the Excellence in Peripheral Arterial Disease and Veterans Affairs North Texas Healthcare System peripheral arterial disease databases. ABI and 12-month major adverse CV events (MACEs, a composite of all-cause death, nonfatal myocardial infarction, need for repeat coronary revascularization, and ischemic stroke) were assessed. Cox proportional hazard models were used to assess the association of ABI and DM with subsequent CV events. An abnormal ABI (<0.9 or >1.4) was present in 72% of patients with stable CAD and 68% had DM. Using patients without DM and normal ABI as reference, the adjusted hazard ratio for 12-month MACE was 1.7 (95% confidence interval [CI] 0.71 to 4.06) for patients with DM and normal ABI; 2.03 (95% CI 0.83 to 4.9) for patients without DM with abnormal ABI; and 4.85 (95% CI 2.22 to 10.61) for patients with DM and abnormal ABI. In conclusion, in patients with stable CAD, an abnormal ABI confers an incremental risk of MACE in addition to DM and traditional CV risk factors.
authors.affiliation: Department of Cardiology, Veterans Affairs North Texas Healthcare System, Dallas, Texas; Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: Subhash.banerjee@va.gov.
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: Department of Cardiology, Veterans Affairs North Texas Healthcare System, Dallas, Texas; Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Ariel
authors.initials: A
authors.lastname: Vinas
authors.affiliation: Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Atif
authors.initials: A
authors.lastname: Mohammad
authors.affiliation: Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Omar
authors.initials: O
authors.lastname: Hadidi
authors.affiliation: Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Rahul
authors.initials: R
authors.lastname: Thomas
authors.affiliation: Department of Cardiology, Veterans Affairs North Texas Healthcare System, Dallas, Texas; Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Karan
authors.initials: K
authors.lastname: Sarode
authors.affiliation: Department of Cardiology, Veterans Affairs North Texas Healthcare System, Dallas, Texas.
authors.forename: Avantika
authors.initials: A
authors.lastname: Banerjee
authors.affiliation: Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Puja
authors.initials: P
authors.lastname: Garg
authors.affiliation: Department of Cardiology, Veterans Affairs North Texas Healthcare System, Dallas, Texas.
authors.forename: Rick A
authors.initials: RA
authors.lastname: Weideman
authors.affiliation: Department of Cardiology, Veterans Affairs North Texas Healthcare System, Dallas, Texas.
authors.forename: Bertis B
authors.initials: BB
authors.lastname: Little
authors.affiliation: Department of Cardiology, Veterans Affairs North Texas Healthcare System, Dallas, Texas; Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013781:Texas / Q000453:epidemiology