Relation between the ankle-brachial index and the complexity of coronary artery disease in older patients

Abstract

BackgroundIn the elderly, the ankle-brachial index (ABI) has greater than 90% sensitivity and specificity for peripheral artery disease identification. A well-known relation exists between peripheral artery disease and the number of diseased coronary vessels. Yet, other anatomical characteristics have important impacts on the type of treatment and prognosis.PurposeTo determine the relation between ABI and the complexity of coronary artery disease, by different anatomical classifications.MethodsThis study was a prospective analysis of patients ≥65 years old who were undergoing elective coronary angiography for ischemic coronary disease. The ABI was calculated for each leg, as the ratio between the lowest ankle pressure and the highest brachial pressure. The analysis of coronary anatomy was performed by three interventional cardiologists; it included classification of each lesion with >50% diameter stenosis, according to the American Heart Association criteria, and calculation of the SYNTAX score.ResultsThe study recruited 204 consecutive patients (median age: 72.5 years). Stable angina was present in 51% of patients. Although only 1% of patients reported peripheral artery disease, 45% exhibited an abnormal ABI. The number of lesions per patient, the number of patients with complex lesions, and the median SYNTAX scores were greater in the group with abnormal ABI. However, among 144 patients with obstructive coronary artery disease, despite abnormal ABI being able to identify a higher rate of patients with B2 or C type lesions (70.9% versus 53.8%; P=0.039), the mean SYNTAX scores (13 versus 9; P=0.14), and the proportion of patients with SYNTAX score >16 (34.2% versus 27.7%; P=0.47), were similar, irrespective of ABI.ConclusionIn patients ≥65 years old the presence of peripheral artery disease could discriminate a group of patients with greater occurrence of B2 and C type lesions, but similar median SYNTAX score.

Analysis of Ankle-Brachial Index, Waist-Hip Ratio, Ejection-Fraction, Obesity, Smoking, Alcohol Habits, Diabetes and Hypertension as Independent Predictors of Complexity and Severity of Coronary Artery Disease

“…Ankle-brachial index (measured <0.9) is an effective non-invasive tool to detect peripheral arterial disease. Since coronary artery disease and peripheral arterial disease are manifestation of atherosclerotic process, it is considered that ankle-brachial index may also reflect coronary atherosclerotic burden [7]. Few studies have also shown a link between ankle-brachial index and Syntax score, a lesion based angiographic scoring system introduced as a tool to grade the complexity of coronary lesions [7] [8].…”

A study to find out relationship in between ankle brachial index and severity of coronary artery disease as assessed by SYNTAX score

“…It is higher than other studies which have reported it to be 60-80% in patient with symptomatic peripheral arterial disease. 2 This higher prevalence of CAD in patient with Low ABI in our study may be due to inclusion of all patients with ABI less than 0.9 irrespective of presence of absence of symptoms and very selective angiography of patient with Stable ischemic heart disease.…”

“…These patients had more extensive and calcified lesions, suggesting a more aggressive form of atherosclerosis. 2 The ankle-brachial index (ABI), which is a non-invasive and inexpensive measurement used to identify PAD has remarkably high sensitivity and specificity (90%, for each), compared against invasive angiography and can be used as indirect measure of CAD severity. 1 Severity of coronary artery diseases varies from minor plaque to diffuse triple vessel disease with different lesion characteristics.…”

“…It has demonstrated that an ABI <0.9 is significantly associated with the complexity and extent of coronary disease and higher average SYNTAX Score. 2 This study was planned to find out relationship between ankle brachial index and severity of coronary artery disease on coronary angiography as assessed by SYNTAX Score.…”

Correlation Abnormal Ankle-Brachial Index and Multivessel Coronary Artery Disease in Acute Coronary Syndrome Patients

“…(5,6) The previous studies have shown PAD correlation with the number of coronary artery lesions and the higher complexity of the lesions. (7,8,9) These correlations might contribute to worse cardiovascular outcomes, especially the acute coronary syndrome (ACS) cases. The aim of this study is to evaluate the correlation abnormal ABI with the risk of ACS patients to have multivessel coronary artery lesions.…”