Predicting Stroke Outcomes Using Ankle-Brachial Index and Inter-Ankle Blood Pressure Difference

Abstract

Background: This study investigated the association of high ankle-brachial index difference (ABID) and systolic inter-ankle blood pressure difference (IAND) with short-and long-term outcomes in acute ischemic stroke patients without peripheral artery disease (PAD). Methods: Consecutive patients with acute ischemic stroke who underwent ankle-brachial index (ABI) measurement were enrolled. ABID was calculated as |right ABI-left ABI|. IAND and systolic inter-arm blood pressure difference (IAD) were calculated as |right systolic blood pressure -left systolic blood pressure|. Poor functional outcome was defined as modified Rankin Scale score ≥3 at 3 months. Major adverse cardiovascular events (MACEs) were defined as stroke recurrence, myocardial infarction, or death. Results: A total of 2901 patients were enrolled and followed up for a median of 3.1 (interquartile range, 1.6-4.7) years. Among them, 2643 (84.9%) patients did not have PAD. In the logistic regression analysis, ABID ≥ 0.15 and IAND ≥ 15 mmHg were independently associated with poor functional outcome (odds ratio (OR), 1.970, 95% confidence interval (CI), 1.175-3.302; OR, 1.665, 95% CI, 1.188-2.334, respectively). In Cox regression analysis, ABID ≥0.15 and IAND ≥ 15 mmHg were independently associated with MACEs (hazard ratio (HR), 1.514, 95% CI, 1.058-2.166; HR, 1.343, 95% CI, 1.051-1.716, respectively) and all-cause mortality (HR, 1.524, 95% CI, 1.039-2.235; HR, 1.516, 95% CI, 1.164-1.973, respectively) in patients without PAD. Conclusion: High ABID and IAND are associated with poor short-term outcomes, long-term MACE occurrence, and all-cause mortality in acute ischemic stroke without PAD.

Low Ankle-Brachial Index Is Associated With Stroke Recurrence in Ischemic Stroke Patients With Atrial Fibrillation

“…The ABI was measured in the supine position using an automatic device (VP-1000; Colin Co., Ltd., Komaki, Japan), which has been validated previously ( 20 ). The device automatically and simultaneously measures four-limb blood pressure using the oscillometric method.…”

Updates in Stroke Treatment, Diagnostic Methods and Predictors of Outcome

“…In total, 32 patients (4.9%) were transfused with packed RBCs during their admission [26]. Patients transfused more than 48 h after hospitalization were found to have a higher probability of poor outcomes at 3 months [26]. Hemoglobin variability during hospitalization, however, was not found to be associated with patient outcomes [26].…”

“…Patients transfused more than 48 h after hospitalization were found to have a higher probability of poor outcomes at 3 months [26]. Hemoglobin variability during hospitalization, however, was not found to be associated with patient outcomes [26]. Despite the inherent limitations of the study design of Kim et al, it being a retrospective cohort study with limited power and high risk of bias due to the presence of unmeasured confounders, it raises the need for further research in order to elucidate the potential impact of blood transfusions timing on the outcomes of patients with recent acute ischemic stroke.…”

“…The impact of hemoglobin status and red blood cell transfusions (RBC) on acute ischemic stroke outcomes is controversial. Kim et al aimed to investigate whether RBC transfusions and hemoglobin variability affects the outcome of patients after an acute ischemic stroke [26]. The authors analyzed data from 2698 patients with acute ischemic stroke admitted in three tertiary hospitals.…”

“…The authors analyzed data from 2698 patients with acute ischemic stroke admitted in three tertiary hospitals. In total, 32 patients (4.9%) were transfused with packed RBCs during their admission [26]. Patients transfused more than 48 h after hospitalization were found to have a higher probability of poor outcomes at 3 months [26].…”