title: Ankle-Brachial Index and Recurrent Stroke Risk: Meta-Analysis.
abstract: OBJECTIVE
  The ankle-brachial index (ABI) is a fast, cheap, noninvasive indicator of atherosclerotic burden that may also be a predictor of stroke recurrence. In this systematic review and meta-analysis, we sought to explore ABI's merit as a marker for stroke recurrence and vascular risk by synthesizing the data currently available in stroke literature.
  
  
  METHODS
  We searched Embase, MEDLINE, and Pubmed databases for prospective cohort studies that included consecutive patients with stroke and transient ischemic attack, measured ABI at baseline, and performed a follow-up assessment at least 12 months after initial stroke or transient ischemic attack. The following end points were chosen for our analysis: recurrent stroke and combined vascular end point (recurrent vascular event or vascular death). Crude risk ratios and adjusted Cox proportional hazard ratios were combined separately using the random-effects model. Study-level characteristics (eg, percent of cohort with a history of hypertension, average cohort age, level of adjustment, and mean follow-up duration) were included as covariates in a metaregression analysis.
  
  
  RESULTS
  We identified 11 studies (5374 patients) that were not significantly heterogeneous. Pooling adjusted hazard ratios showed that low ABI was associated with both an increased hazard of recurrent stroke (hazard ratio, 1.70; 95% confidence interval, 1.10-2.64) and an increased risk of vascular events or vascular death (hazard ratio, 2.22; 95% confidence interval, 1.67-2.97).
  
  
  CONCLUSIONS
  Our results confirm the positive association between ABI and stroke recurrence. Further studies are needed to see whether inclusion of ABI will help improve the accuracy of prediction models and management of stroke patients.
authors.affiliation: From the Center for Stroke Research Berlin (CSB) (J.B.H., C.O.L., M.E., B.S., T.G.L.), Klinik und Poliklinik für Neurologie (M.E., T.G.L.), German Center for Neurodegenerative Disease (DZNE) (M.E.), and German Center for Cardiovascular Research (DZHK) (M.E.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany (M.E.); and Department of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY (T.G.L.).
authors.forename: Ja Bin
authors.initials: JB
authors.lastname: Hong
authors.affiliation: From the Center for Stroke Research Berlin (CSB) (J.B.H., C.O.L., M.E., B.S., T.G.L.), Klinik und Poliklinik für Neurologie (M.E., T.G.L.), German Center for Neurodegenerative Disease (DZNE) (M.E.), and German Center for Cardiovascular Research (DZHK) (M.E.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany (M.E.); and Department of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY (T.G.L.).
authors.forename: Christopher O
authors.initials: CO
authors.lastname: Leonards
authors.affiliation: From the Center for Stroke Research Berlin (CSB) (J.B.H., C.O.L., M.E., B.S., T.G.L.), Klinik und Poliklinik für Neurologie (M.E., T.G.L.), German Center for Neurodegenerative Disease (DZNE) (M.E.), and German Center for Cardiovascular Research (DZHK) (M.E.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany (M.E.); and Department of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY (T.G.L.).
authors.forename: Matthias
authors.initials: M
authors.lastname: Endres
authors.affiliation: From the Center for Stroke Research Berlin (CSB) (J.B.H., C.O.L., M.E., B.S., T.G.L.), Klinik und Poliklinik für Neurologie (M.E., T.G.L.), German Center for Neurodegenerative Disease (DZNE) (M.E.), and German Center for Cardiovascular Research (DZHK) (M.E.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany (M.E.); and Department of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY (T.G.L.).
authors.forename: Bob
authors.initials: B
authors.lastname: Siegerink
authors.affiliation: From the Center for Stroke Research Berlin (CSB) (J.B.H., C.O.L., M.E., B.S., T.G.L.), Klinik und Poliklinik für Neurologie (M.E., T.G.L.), German Center for Neurodegenerative Disease (DZNE) (M.E.), and German Center for Cardiovascular Research (DZHK) (M.E.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany (M.E.); and Department of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY (T.G.L.).
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Liman
mesh_terms: D000367:Age Factors; D055109:Ankle Brachial Index / Q000706:statistics & numerical data*; D050197:Atherosclerosis / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D002546:Ischemic Attack, Transient / Q000453:epidemiology*; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology*
keywords: ankle-brachial index; ischemic attack, transient; regression analysis; risk; stroke