title: Ankle-Brachial Index and cardiovascular events in atrial fibrillation. The ARAPACIS Study.
abstract: Atrial fibrillation (AF) patients are at high risk for thrombotic and vascular events related to their cardiac arrhythmia and underlying systemic atherosclerosis. Ankle-Brachial Index (ABI) is a non-invasive tool in evaluating systemic atherosclerosis, useful in predicting cardiovascular events in general population; no data are available in AF patients. ARAPACIS is a prospective multicentre observational study performed by the Italian Society of Internal Medicine, analysing association between low ABI (≤ 0.90) and vascular events in NVAF out- or in-patients, enrolled in 136 Italian centres. A total of 2,027 non-valvular AF (NVAF) patients aged > 18 years from both sexes followed for a median time of 34.7 (interquartile range: 22.0-36.0) months, yielding a total of 4,614 patient-years of observation. Mean age was 73 ± 10 years old with 55 % male patients. A total of 176 patients (8.7 %) experienced a vascular event, with a cumulative incidence of 3.81 %/patient-year. ABI≤ 0.90 was more prevalent in patients with a vascular event compared with patients free of vascular events (32.2 vs 20.2 %, p< 0.05). On Cox proportional hazard analysis, ABI≤ 0.90 was an independent predictor of vascular events (hazard ratio (HR): 1.394, 95 % confidence interval (CI): 1.042-1.866; p=0.02), vascular death (HR: 2.047, 95 % CI: 1.255-3.338; p=0.004) and MI (HR: 2.709, 95 % CI: 1.485-5.083; p=0.001). This latter association was also confirmed after excluding patients with previous MI (HR: 2.901, 95 % CI: 1.408-5.990, p=0.004). No association was observed between low ABI and stroke/transient ischaemic attack (p=0.91). In conclusion, low ABI is useful to predict MI and vascular death in NVAF patients and may independently facilitate cardiovascular risk assessment in NVAF patients.
authors.affiliation: Prof. Francesco Violi, I Clinica Medica, Sapienza-University of Rome, Viale del Policlinico 155, Rome, 00161, Italy, Tel.: +39 06 4461933, Fax: +39 06 49970103, E-mail: francesco.violi@uniroma1.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Violi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Davì
authors.forename: Marco
authors.initials: M
authors.lastname: Proietti
authors.forename: Daniele
authors.initials: D
authors.lastname: Pastori
authors.forename: William R
authors.initials: WR
authors.lastname: Hiatt
authors.forename: Gino Roberto
authors.initials: GR
authors.lastname: Corazza
authors.forename: Francesco
authors.initials: F
authors.lastname: Perticone
authors.forename: Pasquale
authors.initials: P
authors.lastname: Pignatelli
authors.forename: Alessio
authors.initials: A
authors.lastname: Farcomeni
authors.forename: Anna Rita
authors.initials: AR
authors.lastname: Vestri
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.forename: Stefania
authors.initials: S
authors.lastname: Basili
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index / Q000379:methods*; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012306:Risk; D016019:Survival Analysis; D014652:Vascular Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality
keywords: ABI; ARAPACIS; Atrial fibrillation; myocardial infarction; vascular events