Low ankle brachial index predicts poor outcomes including target lesion revascularization during the long-term follow up after drug-eluting stent implantation for coronary artery disease

Abstract

Background: Peripheral arterial disease (PAD) frequently coexists with coronary artery disease (CAD). The ankle-brachial index (ABI) is widely used for the screening for PAD. Low ABI is associated with short-term clinical outcomes in patients receiving coronary drug-eluting stent (DES) implantation. However, there is no report to examine the relationship between lower ABI and long-term clinical outcomes after DES implantation. Thus, we investigated the clinical long-term impact of low ABI after DES implantation. Methods: This retrospective analysis included 181 CAD patients treated with DES from April 2010 to March 2013 in our institute. Based on ABI values, we divided the subjects into the low-ABI group(ABI [ 6 1 _ T D $ D I F F ] < 0.9, n = 29) and the normal ABI group(0.9 [ 6 2 _ T D $ D I F F ] ABI < 1.4, n = 152). The incidence of target lesion revascularization (TLR), all-cause mortality, and major adverse cardiac and cerebrovascular events (MACCE) defined as a composite of cardiac death, myocardial infarction, stroke, and any repeat revascularization, were compared between the 2 groups. Results: During the median follow-up period of 43 months, the incidences of TLR, all-cause mortality, and MACCE were significantly higher in the low ABI group than in the normal ABI group (TLR: 41.4% vs 9.9%, p [ 6 3 _ T D $ D I F F ] < 0.001, all-cause mortality: 31.0% vs 3.9%, p [ 6 3 _ T D $ D I F F ] < 0.001, MACCE: 48.3% vs 11.2%, p [ 6 3 _ T D $ D I F F ] < 0.001, respectively). Conclusions: Low ABI may predict poor long-term outcomes, including TLR, in CAD patients treated with DES.

Prognostic Value of Abnormal Ankle–Brachial Index in Patients With Coronary Artery Disease: A Meta-Analysis

“…After applying our predefined inclusion and exclusion criteria, 49 studies were further removed for various reasons. Thus, 9 studies 9,11 –17,22 were finally included in the meta-analysis.…”

“…Seven studies 9,11 –14,17,22 reported the MACE as an outcome measure. As shown in Figure 2, a fixed-effect model was selected because there was no significant between-study heterogeneity ( I 2 = 27.2%, P = .212).…”

“…Five studies 9,13,15 –17 reported all-cause mortality as an outcome measure. As shown in Figure 4, there was no evidence of significant heterogeneity between studies ( I 2 = 0%, P = .715).…”

“…However, the prognostic use of an abnormal ABI for predicting all-cause mortality is conflicting in these patients. 9,13,15 –17 No previous meta-analysis has specifically focused on the prognostic value of abnormal ABI in patients with CAD. The present meta-analysis aimed to assess the association of abnormal ABI with the risk of MACE or all-cause mortality in patients with CAD.…”

Association of Ankle Brachial Index with Clinical Outcomes Following Percutaneous Coronary Intervention in Patients with Aortic Aneurysm

“…The ankle brachial index (ABI) has been reported as an indicator of clinical outcomes in patients who underwent PCI (8)(9)(10). ABI is widely performed in patients with TAA/ AAA, as TAA/AAA is often complicated with peripheral artery disease (11).…”