title: Toe Pressure and Toe Brachial Index are Predictive of Cardiovascular Mortality, Overall Mortality, and Amputation Free Survival in Patients with Peripheral Artery Disease.
abstract: OBJECTIVE
  Peripheral haemodynamic parameters are used to assess the presence and severity of peripheral artery disease (PAD). The prognostic value of ankle brachial index (ABI) has been thoroughly delineated. Nonetheless, the relative usefulness of ankle pressure (AP), ABI, toe pressure (TP), and toe brachial index (TBI) in assessing patient outcome has not been investigated in a concurrent study setting. This study aimed to resolve the association of all four non-invasive haemodynamic parameters in clinically symptomatic patients with PAD with cardiovascular mortality, overall mortality, and amputation free survival (AFS).
  
  
  METHODS
  In total, 732 symptomatic patients with PAD admitted to the Department of Vascular Surgery for conventional angiography at Turku University Hospital, Turku, Finland, between January 2009 and August 2011 were reviewed retrospectively. Demographic factors, cardiovascular mortality, all-cause mortality, and above foot level amputations were obtained and assessed in relation to AP, ABI, TP, and TBI by means of Kaplan-Meier life tables and a multivariate Cox regression model.
  
  
  RESULTS
  The haemodynamic parameter that was associated with poor 36 month general outcome was TP < 30 mmHg. Univariate Cox regression analysis of stratified values showed that TP and TBI associated significantly with mortality. In multivariate analysis both TP and TBI were associated with a significant risk of death. For TP < 30 mmHg and TBI < 0.25 the risk of cardiovascular mortality was hazard ratio [HR] 2.84, 95% confidence interval [CI] 1.75-4.61 [p<.001]; HR 3.68, 95% CI 1.48-9.19 [p=.050], respectively; all-cause mortality (HR 2.05, 95% CI 1.44-2.92 [p<.001]; HR 2.53, 95% CI 1.35-4.74 [p=.040], respectively); and amputation or death (HR 2.13, 95% CI 1.52-2.98 [p<.001]; HR 2.46, 95% CI 1.38-4.40 [p=.050], respectively)...
  
  
  CONCLUSIONS
  Among non-invasive haemodynamic measurements and pressure indices both TP and TBI appear to be associated with cardiovascular and overall mortality and AFS for patients with PAD presenting symptoms of the disease.
authors.affiliation: Department of Vascular Surgery, Turku University Hospital and University of Turku, Turku, Finland.
authors.forename: J-E
authors.initials: JE
authors.lastname: Wickström
authors.affiliation: Department of Vascular Surgery, University Hospital of Helsinki, Helsinki, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Laivuori
authors.affiliation: Department of Vascular Surgery, Turku University Hospital and University of Turku, Turku, Finland.
authors.forename: E
authors.initials: E
authors.lastname: Aro
authors.affiliation: Centre for Research Methods, Department of Social Research, University of Helsinki, Helsinki, Finland.
authors.forename: R T
authors.initials: RT
authors.lastname: Sund
authors.affiliation: Department of Vascular Surgery, Turku University Hospital and University of Turku, Turku, Finland.
authors.forename: O
authors.initials: O
authors.lastname: Hautero
authors.affiliation: Department of Vascular Surgery, University Hospital of Helsinki, Helsinki, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Venermo
authors.affiliation: Department of Vascular Surgery, Turku University Hospital and University of Turku, Turku, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Jalkanen
authors.affiliation: Department of Vascular Surgery, Turku University Hospital and University of Turku, Turku, Finland. Electronic address: haheha@utu.fi.
authors.forename: H
authors.initials: H
authors.lastname: Hakovirta
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D055109:Ankle Brachial Index; D001794:Blood Pressure; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D005387:Finland; D006785:Hospitals, University; D006801:Humans; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014034:Toes / Q000098:blood supply*; D016896:Treatment Outcome
keywords: ABI; Amputation free survival; Ankle pressure; Mortality; TBI; Toe pressure