title: Prognostic significance of ankle brachial pressure index: A systematic review and meta-analysis.
abstract: Purpose To synthesize and quantify the excess risk of morbidity and mortality in individuals with low ankle-brachial pressure index. Methods Electronic databases were searched to identify studies investigating morbidity and mortality outcomes in individuals undergoing ankle-brachial pressure index measurement. Meta-analysis of the outcomes was performed using fixed- or random-effects models. Uncertainties related to varying follow-up periods among the studies were resolved by meta-analysis of time-to-event outcomes. Results Forty-three observational cohort studies, enrolling 94,254 participants, were selected. A low ankle-brachial pressure index (<0.9) was associated with a significant risk of all-cause mortality (risk ratio: 2.52, 95% CI 2.26-2.82, P < 0.00001); cardiovascular mortality (risk ratio: 2.94, 95% CI 2.72-3.18, P < 0.00001); cerebrovascular event (risk ratio: 2.17, 95% CI 1.90-2.47, P < 0.00001); myocardial infarction (risk ratio: 2.28, 95% CI 2.07-2.51, P < 0.00001); fatal myocardial infarction (risk ratio: 2.81, 95% CI 2.33-3.40, P < 0.00001); fatal stroke (risk ratio: 2.28, 95% CI 1.80-2.89, P < 0.00001); and the composite of myocardial infarction, stroke, and death (risk ratio: 2.29, 95% CI 1.87-2.81, P < 0.00001). Similar findings resulted from analyses of individuals with asymptomatic PAD, individuals with cardiovascular or cerebrovascular co-morbidity, and patients with diabetes. Conclusions A low ankle-brachial pressure index is associated with an increased risk of subsequent cardiovascular and cerebrovascular morbidity and mortality. Randomised controlled trials are required to investigate the effectiveness of screening for PAD in asymptomatic and undiagnosed individuals and to evaluate benefits of early treatment of screen-detected PAD.
authors.affiliation: 1 Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital & University Hospital Aintree, Liverpool, UK.
authors.forename: Shahab
authors.initials: S
authors.lastname: Hajibandeh
authors.affiliation: 1 Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital & University Hospital Aintree, Liverpool, UK.
authors.forename: Shahin
authors.initials: S
authors.lastname: Hajibandeh
authors.affiliation: 1 Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital & University Hospital Aintree, Liverpool, UK.
authors.forename: Sohan
authors.initials: S
authors.lastname: Shah
authors.affiliation: 2 Library Resource & Information Centre, University Hospital Aintree, Liverpool, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Child
authors.affiliation: 3 Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, The Pennine Acute Hospitals NHS Trust, Manchester, UK.
authors.forename: George A
authors.initials: GA
authors.lastname: Antoniou
authors.affiliation: 1 Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital & University Hospital Aintree, Liverpool, UK.
authors.forename: Francesco
authors.initials: F
authors.lastname: Torella
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D002561:Cerebrovascular Disorders / Q000401:mortality / Q000503:physiopathology; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
keywords: Ankle brachial pressure index; morbidity; mortality; peripheral arterial disease; screening