The Long-term Prognostic Value of the Resting and Postexercise Ankle-brachial Index.
From: Department of Anesthesiology, Erasmus Medical Centre, Rotterdam, Netherlands.
Archives of internal medicine
- Publish Date: Mar 2006
- ISSN: 0003-9926
- Volume: 166
- Issue: 5
- Pages: 529-35
- Medium: Print
- Language: English
- Citation (JAMA): Feringa Harm H H, Bax Jeroen J J, van Waning Virginie H, et al. The Long-term Prognostic Value of the Resting and Postexercise Ankle-brachial Index.. Arch. Intern. Med. Mar 2006;166:529-35
Abstract
BACKGROUND: Peripheral arterial disease is associated with a high incidence of cardiovascular mortality. Peripheral arterial disease can be detected by using the ankle-brachial index (ABI). This study assessed the prognostic value of the postexercise ABI in addition to the resting ABI on long-term mortality in patients with suspected peripheral arterial disease. METHODS: In this prospective cohort study of 3209 patients (mean +/- SD age, 63 +/- 12 years; 71.1% male), resting and postexercise ABI values were measured and a reduction of postexercise ABI over baseline resting readings was calculated. The mean follow-up was 8 years (interquartile range, 4-11 years). RESULTS: During follow-up, 1321 patients (41.2%) died. After adjusting for clinical risk factors, lower resting ABI values (hazard ratio per 0.10 lower ABI, 1.08; 95% confidence interval [CI], 1.06-1.10), lower postexercise ABI values (hazard ratio per 0.10 lower ABI, 1.09; 95% CI, 1.08-1.11), and higher reductions of ABI values over baseline readings (hazard ratio per 10% lower ABI, 1.12; 95% CI, 1.09-1.14) were significantly associated with a higher incidence of mortality. In patients with a normal resting ABI (n = 789), a reduction of the postexercise ABI by 6% to 24%, 25% to 55%, and greater than 55% was associated with a 1.6-fold (95% CI, 1.2-2.2), 3.5-fold (95% CI, 2.4-5.0), and 4.8-fold (95% CI, 2.5-9.1) increased risk of mortality, respectively. CONCLUSIONS: Resting and postexercise ABI values are strong and independent predictors of mortality. A reduction of postexercise ABI over baseline readings can identify additional patients (who have normal ABI values at rest) at increased risk of subsequent mortality.
Mesh Headings (Keywords): Ankle, Blood Pressure, Brachial Artery, Disease Progression, Exercise, Female, Follow-Up Studies, Humans, Intermittent Claudication, Male, Middle Aged, Odds Ratio, Prognosis, Prospective Studies, Rest, Risk Factors, Survival Rate, Tibial Arteries, Ultrasonography, Doppler
Check for Full Text / PubMed Unique Identifier (PMID): 16534039
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