Impressive predictive value of ankle-brachial index for very long-term outcomes in patients with cardiovascular disease: IMPACT-ABI study

Miura, Takashi; Minamisawa, Masatoshi; Ueki, Yasushi; Abe, Naoyuki; Nishimura, Hitoshi; Hashizume, Naoto; Mochidome, Tomoaki; Harada, Mikiko; Oguchi, Yasutaka; Yoshie, Koji; Shoin, Wataru; Saigusa, Tatsuya; Ebisawa, Soichiro; Motoki, Hirohiko; Koyama, Jun; Ikeda, Uichi; Kuwahara, Koichiro

doi:10.1371/journal.pone.0177609

Cited by 24 publications

(12 citation statements)

References 22 publications

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“…The Ankle-Brachial Index (ABI) is a simple and non-invasive tool used to diagnose Peripheral arterial disease (PAD). An ABI of <0.9 has been considered abnormal and has been not only associated with the diagnosis of PAD, but has been also a marker of incident cardiovascular events and mortality in both symptomatic and asymptomatic forms of PAD [1–7]. It has been repeatedly associated with a three to six times greater risk of cardiovascular events and mortality [8].…”

Section: Introductionmentioning

confidence: 99%

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Low, borderline and normal ankle-brachial index as a predictor of incidents outcomes in the Mediterranean based-population ARTPER cohort after 9 years follow-up

et al. 2019

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BackgroundGuidelines recommended adopting the same cardiovascular risk modification strategies used for coronary disease in case of low Ankle-brachial index (ABI), but here exist few studies on long-term cardiovascular outcomes in patients with borderline ABI and even fewer on the general population.AimThe aim of the present study was to analyze the relationship between long-term cardiovascular events and low, borderline and normal ABI after a 9-year follow up of a Mediterranean population with low cardiovascular risk.Design and settingA population-based prospective cohort study was performed in the province of Barcelona, Spain.MethodA total of 3,786 subjects >49 years were recruited from 2006–2008. Baseline ABI was 1.08 ± 0.16. Subjects were followed from the time of enrollment to the end of follow-up in 2016 via phone calls every 6 months, systematic reviews of primary-care and hospital medical records and analysis of the SIDIAP (Information System for Primary Care Research) database to confirm the possible appearance of cardiovascular events.Results3146 individuals participated in the study. 2,420 (77%) subjects had normal ABI, 524 (17%) had borderline ABI, and 202 (6.4%) had low ABI.In comparison with normal and borderline subjects, patients with lower ABI had more comorbidities, such as hypertension, hypercholesterolemia and diabetes.Cumulative MACE incidence at 9 years was 20% in patients with low ABI, 6% in borderline ABI and 5% in normal ABI.The annual MACE incidence after 9 years follow-up was significantly higher in people with low ABI (26.9/1000py) (p<0.001) than in borderline (6.6/1000py) and in normal ABI (5.6/1000py).Subjects with borderline ABI are at significantly higher risk for coronary disease (HR: 1.58; 95% CI: 1.02–2, 43; p = 0,040) compared to subjects with normal ABI, after adjustment.ConclusionThe results of the present study support that low ABI was independently associated with higher incidence of MACE, ICE, cardiovascular and no cardiovascular mortality; while borderline ABI had significantly moderate risk for coronary disease than normal ABI.

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Section: Introductionmentioning

confidence: 99%

“…Several studies carried out in countries with high and low rates of cardiovascular disease have detected a high incidence of cardiovascular events and mortality in patients with PAD [1–7].…”

Section: Introductionmentioning

confidence: 99%

Low, borderline and normal ankle-brachial index as a predictor of incidents outcomes in the Mediterranean based-population ARTPER cohort after 9 years follow-up

et al. 2019

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“…The IMPACT-ABI study showed that the incidence of stroke was significantly higher in the low ABI (≤0.9) and borderline ABI (0.91–0.99) than those with normal ABI (1.00–1.40) in patients hospitalized for cardiovascular disease during a 4.8-year mean follow-up period. 25 In the study of surveillance of cardiovascular events in antiplatelet-treated arteriosclerosis obliterans patients in Japan (SEASON), Miyata et al. found that those with ABI < 0.9 had a significantly higher risk of any vascular events (including cerebrovascular and cardiovascular events) and all-cause death compared to normal ABI.…”

Section: Discussionmentioning

confidence: 99%

Predictive value of ankle–brachial index for long-term events of ischemic stroke in hemodialysis patients

et al. 2020

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Objectives The ankle–brachial index is a noninvasive modality to evaluate atherosclerosis and is a predictive role for future cardiovascular events and mortality. However, few studies have evaluated its relation to long-term future ischemic stroke in hemodialysis patients. Therefore, we examined the relationship between ankle–brachial index and ischemic stroke events among hemodialysis patients in a seven-year follow-up. Methods A total of 84 patients were enrolled. Ankle–brachial index was assessed in January 2009. Primary outcomes included ischemic stroke. An ankle–brachial index < 0.9 was considered abnormal and 1.4 ≥ ankle–brachial index ≥ 0.9 to be normal ankle–brachial index. Results Mean values for ankle–brachial index were 0.98 ± 0.21at study entrance. In addition, 28 patients encountered ischemic stroke in the seven-year follow-up. In univariate Cox regression analysis, old age (hazard ratio (HR): 1.065, 95% confidence interval (CI): 1.030–1.102, p < 0.001), low seven-year averaged serum phosphate levels (HR: 0.473, 95% CI: 0.306–0.730, p = 0.001), and abnormal ankle–brachial index (HR: 0.035, 95% CI: 0.009–0.145, p < 0.001) were risk factors for ischemic stroke. In multivariate Cox regression analysis for significant variables in univariate analysis, abnormal ankle–brachial index (HR: 0.058, 95% CI: 0.012–0.279, p < 0.001) and low seven-year averaged serum phosphate levels (HR: 0.625, 95% CI: 0.404–0.968, p = 0.035) remained the risk factors for ischemic stroke. The risk of ischemic stroke was 3.783-fold in patients with abnormal ankle–brachial index compared with patients with normal ankle–brachial index (HR: 3.783, 95% CI: 1.731–8.269, p = 0.001). Conclusions These findings suggest that ankle–brachial index is an impressive predictor of future ischemic stroke among hemodialysis patients.

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“…Former studies described that the score of ABI tended to be higher in HD patients than Non-HD cohort. 20,21 Therefore, there is a possibility that our Non-PAD groups in our study might include several PAD patients, if we conducted the image test to them in detail. However, it is important that our results are derived by non-invasive and simple examination, and the present association between PAD and frailty, such as the lower grip strength and smaller thigh circumference values in patients with PAD was not changed according to the definition of PAD as ABI <1.0.…”

Section: Discussionmentioning

confidence: 99%

Peripheral artery disease is associated with frailty in chronic hemodialysis patients

et al. 2018

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Objectives The clinical condition of frailty is a common problem in the elderly population. However, the relationship between peripheral artery disease and frailty in hemodialysis patients remains unknown. The aim of this study was to identify the relationships between peripheral artery disease and frailty in Japanese chronic hemodialysis patients. Methods A total of 362 chronic hemodialysis patients who regularly visited six institutions were enrolled. To evaluate frailty, the modified Fried's frailty phenotype adjusted for Japanese were used. Peripheral artery disease was defined as ankle-brachial index <0.9. Results Of 362 patients, 62 patients (17.1%) were categorized as peripheral artery disease group and 300 patients (82.9%) as Non-peripheral artery disease group. The prevalence of frailty in the peripheral artery disease group was significantly higher than in the Non-peripheral artery disease group (34% vs. 18%, P = 0.0103). Non-shunt side grip strength was significantly stronger in the Non-peripheral artery disease group (23.6 kg vs. 17.0 kg, P < 0.0001). Thigh circumferences were also significantly larger in the Non-peripheral artery disease group (41.7 cm vs. 39.7 cm, P = 0.0054). A multivariate logistic regression analysis demonstrated that the factors independently associated with peripheral artery disease were as follows: frailty (odds ratio = 2.06, 95% confidence interval 1.09-3.89) and myocardial infarction (odds ratio = 3.74, 95% confidence interval 2.05-6.83). Conclusions It is concluded that peripheral artery disease is closely associated with frailty in hemodialysis patients.

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Impressive predictive value of ankle-brachial index for very long-term outcomes in patients with cardiovascular disease: IMPACT-ABI study

Cited by 24 publications

References 22 publications

Low, borderline and normal ankle-brachial index as a predictor of incidents outcomes in the Mediterranean based-population ARTPER cohort after 9 years follow-up

Low, borderline and normal ankle-brachial index as a predictor of incidents outcomes in the Mediterranean based-population ARTPER cohort after 9 years follow-up

Predictive value of ankle–brachial index for long-term events of ischemic stroke in hemodialysis patients

Peripheral artery disease is associated with frailty in chronic hemodialysis patients

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