title: Clinical Characteristics and Outcomes of Patients with High Ankle-Brachial Index from the IMPACT-ABI Study.
abstract: BACKGROUND
  Reduced ankle-brachial index (ABI) is a predictor of cardiovascular events. However, the significance of high ABI remains poorly understood. This study aimed to assess the characteristics and outcomes of patients with high ABI.
  
  
  METHODS
  The IMPACT-ABI study was a retrospective cohort study that enrolled and examined ABI in 3,131 patients hospitalized for cardiovascular disease between January 2005 and December 2012. From this cohort, 2,419 patients were identified and stratified into two groups: high ABI (> 1.4; 2.6%) and normal ABI (1.0-1.4; 97.3%). The primary endpoint was the cumulative incidence of major adverse cardiovascular events (MACE), including cardiovascular-associated death, myocardial infarction, and stroke.
  
  
  RESULTS
  Compared with the normal ABI group, patients in the high ABI group showed significantly lower body mass index (BMI) and hemoglobin level, but had higher incidence of chronic kidney disease and hemodialysis. Multivariate logistic regression analysis revealed that hemodialysis was the strongest predictor of high ABI (odds ratio, 6.18; 95% confidence interval (CI), 3.05-12.52; P < 0.001). During the follow-up (median, 4.7 years), 172 cases of MACE occurred. Cumulative MACE incidence in patients with high ABI was significantly increased compared to that in those with normal ABI (32.5% vs. 14.5%; P = 0.005). In traditional cardiovascular risk factors-adjusted multivariate Cox proportional hazard analysis, high ABI was an independent predictor of MACE (hazard ratio, 2.07; 95% CI, 1.02-4.20; P = 0.044).
  
  
  CONCLUSIONS
  Lower BMI, chronic kidney disease, and hemodialysis are more frequent in patients with high ABI. Hemodialysis is the strongest predictor of high ABI. High ABI is a parameter that independently predicts MACE.
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Nishimura
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Miura
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Minamisawa
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ueki
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Abe
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Hashizume
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Mochidome
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Mikiko
authors.initials: M
authors.lastname: Harada
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Shimizu
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Shoin
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Yoshie
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Oguchi
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Ebisawa
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Motoki
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Izawa
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Koyama
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Uichi
authors.initials: U
authors.lastname: Ikeda
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kuwahara
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000503:physiopathology; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000503:physiopathology; D012189:Retrospective Studies; D020521:Stroke / Q000401:mortality* / Q000503:physiopathology