Prognostic value of the ankle-brachial index in elderly patients with a stable chronic cardiovascular event

Abstract

Background and Objectives: Patients with polyvascular arterial disease have a greater risk of suffering a new atherothrombotic episode than those with involvement of only one vascular territory. We have studied the predictive prognostic value of the detection of non-diagnosed peripheral arterial disease, determined by measuring the ankle-brachial index in a population of elderly patients with stable chronic cardiac or cerebrovascular disease. Methods: This was a multicenter, prospective cohort study with consecutive inclusion of patients between 65 and 85 years of age with a previous atherothrombotic event, but without previously established peripheral arterial disease. Results: A total of 1096 patients were evaluated during 11.7 (± 2.2) months of follow-up. An ankle-brachial index of < 0.9 was observed in 29.9% and > 1.4 in 6.9%. The detection of an ankle-brachial index < 0.9 was clearly associated with the presence of a combined primary event of cardiovascular death and non-fatal cardiovascular event [HR 1.99 (95% CI, 1.49-2.66; P < 0.001)]. There was also a significant relationship between ankle-brachial index > 1.4 and total (P = 0.001) or cardiovascular (P = 0.020) deaths. The predictive value of both ranges of the ankle-brachial index was maintained after adjusting for age, sex, diabetes mellitus, vascular territory, macroalbuminuria or glomerular filtration rate. Conclusions: The detection of non-diagnosed peripheral arterial disease in patients with stable coronary or cerebrovascular events identifies a very high risk population that might benefit from more intensive treatment. © 2010 International Society on Thrombosis and Haemostasis.