Significance of an Abnormal Ankle-Brachial Index in Patients With Established Coronary Artery Disease With and Without Associated Diabetes Mellitus

Banerjee, Subhash; Vinas, Ariel; Mohammad, Atif; Hadidi, Omar; Thomas, Rahul; Sarode, Karan; Banerjee, Avantika; Garg, Puja; Weideman, Rick; Little, Bertis B.; Brilakis, Emmanouil S.

doi:10.1016/j.amjcard.2014.01.403

Cited by 12 publications

(17 citation statements)

References 19 publications

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“…Banerjee et al demonstrated that in patients with chronic stable CAD, an abnormal ABI confers an increased risk of cardiovascular events, independent from traditional risk factors [ 24 ]. These results confirmed previous study published by Lee et al [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Association Between Ankle-Brachial Index and Coronary Lesions Assessed by Coronary Angiography

Oliveira¹,

Correia²,

Neto³

et al. 2015

Cardiol Res

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BackgroundThe ankle-brachial index (ABI) is a simple, non-invasive, and inexpensive method used in the diagnosis of peripheral arterial disease (PAD) and can identify individuals at risk for cardiovascular disease in other arteries of the body, especially the coronary and carotid arteries. The primary objective of this study was to assess whether patients with an ABI < 0.9 have more severe coronary artery disease detected on coronary angiography compared to patients with a normal ABI.MethodsThis is a prospective, analytical, cross-sectional study that was performed from July 1, 2013 to June 31, 2014 that recruited 163 patients (101 men (62%) and 62 women (38%)) according to the inclusion and exclusion criteria. All patients underwent coronary angiography, and then ABI measurements were performed. Pearson’s Chi-square and Student’s t-tests were used to compare variables between groups. The Poisson regression model was used to evaluate whether ABI was an independent predictor of stenoses > 50%.ResultsThe prevalence of ABI < 0.9 was 9.8%. Patients with an ABI < 0.9 had a higher prevalence of stenoses ≥ 50% in the left anterior descendant (LAD) (68.7% vs. 36%, P = 0.02) and left main (8.7% vs. 0.6%, P < 0.001) than those with a normal ABI. On multivariate Poisson regression, an ABI < 0.9 was an independent predictor of stenosis ≥ 50% in the LAD (odds ratio (OR): 2.05 (1.39 - 3.04), P < 0.001).ConclusionsPatients with an ABI < 0.9 had a higher prevalence of stenoses ≥ 50% in the LAD and left main than those with a normal ABI. An abnormal ABI was an independent predictor of lesions ≥ 50% in LAD.

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Section: Discussionmentioning

confidence: 99%

Association Between Ankle-Brachial Index and Coronary Lesions Assessed by Coronary Angiography

Oliveira¹,

Correia²,

Neto³

et al. 2015

Cardiol Res

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“…The presence of low ABI, defined as <0.9, has been proposed as a modifier of total cardiovascular risk [7]. This association has been assessed in general population, independently from the Framingham risk score [10]; in persons with diabetes [11,12]; and in persons with previous history of coronary artery disease, in addition to diabetes mellitus and traditional risk factors [13]. To date, no studies have examined the extent to which the impact of low ABI is affected by the simultaneous presence or absence of conditions known to increase risk, like diabetes and previous CVD.…”

Section: Introductionmentioning

confidence: 99%

Role of Low Ankle–Brachial Index in Cardiovascular and Mortality Risk Compared with Major Risk Conditions

Alves-Cabratosa

García-Gil

Comas-Cufí

et al. 2019

JCM

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Cardiovascular prevention is of particular interest in persons with asymptomatic peripheral arterial disease. We aimed to quantify its association with mortality and cardiovascular outcomes, compared to other indicators of high risk. We performed a retrospective cohort study using the Database of the Catalan primary care system (SIDIAPQ), for 2006–2015, including 35–85-year-old patients with an ankle–brachial index (ABI) measurement, classified according to the presence of diabetes, cardiovascular disease, and low ABI (<0.9). We calculated the incidences and hazard ratios (HRs) for all-cause mortality, acute myocardial infarction, and ischemic stroke. During a median follow-up of 5.9 years, we analyzed 58,118 persons. The mean (SD) age was 66.6 (10.7) years and 53.4% were men. Compared to the reference group with no diabetes, no previous cardiovascular disease, and normal ankle–brachial index, the HR for all-cause mortality was 1.42 (1.25–1.63) in the group with low ABI, 1.35 (1.26–1.45) in those with diabetes, 1.50 (1.34–1.69) in those with previous cardiovascular disease, and 1.84 (1.68–2.01) in those with low ABI and diabetes. In conclusion, participants with low ABI showed increased mortality, acute myocardial infarction, and ischemic stroke incidence in all the subgroups. Patients with low ankle–brachial index plus diabetes presented increased mortality, acute myocardial infarction, and ischemic stroke risk, all at rates similar to those with previous cardiovascular disease.

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“…Also, Zellweger et al combined several traditional risk factors of CAD to screen the asymptomatic high-risk patients with diabetes and to predict the abnormal score of MPI [ 43 ]. Ankle-brachial index (ABI) has been proved to be associated with CAD [ 44 – 47 ], and low ABI was investigated as a predictor of CAD [ 48 , 49 ]. Diabetic patients with microalbuminuria (albumin-to-creatinine ratio: 30–300 mg/g) had also been confirmed with increased risk of CAD [ 50 ].…”

Section: Discussionmentioning

confidence: 99%

The First Harmonic of Radial Pulse as an Early Predictor of Silent Coronary Artery Disease and Adverse Cardiac Events in Type 2 Diabetic Patients

Chang

Liao

Chang

et al. 2018

Cardiology Research and Practice

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Background It has been reported that harmonics of radial pulse is related to coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM). It is still unclear whether or not the first harmonics of the radial pulse spectrum is an early independent predictor of silent coronary artery disease (SCAD) and adverse cardiac events (ACE). Objectives To measure the risk of SCAD in patients with T2DM and also to survey whether or not an increment of the first harmonic (C1) of the radial pulse increases ACE. Methods 1968 asymptomatic individuals with T2DM underwent radial pulse wave measurement. First harmonic of the radial pressure wave, C1, was calculated. Next, the new occurrence of ACE and the new symptoms and signs of coronary artery disease were recorded. The follow-up period lasted for 14.7 ± 3.5 months. Results Out of 1968 asymptomatic individuals with T2DM, ACE was detected in 239 (12%) of them during the follow-up period. The logrank test demonstrated that the cumulative incidence of ACE in patients with C1 above 0.96 was greater than that in those patients with C1 below 0.89 (P < 0.01). By comparing the data of patients with C1 smaller than the first quartile and the patients with C1 greater than the third quartile, the hazard ratios were listed as follows: ACE (hazard ratio, 2.29; 95% CI, 1.55–3.37), heart failure (hazard ratio, 2.22; 95% CI, 1.21–4.09), myocardial infarction (hazard ratio, 2.44; 95% CI, 1.51–3.93), left ventricular dysfunction (Hazard ratio, 2.01; 95% CI, 0.86–4.70), and new symptoms and signs for coronary artery disease (hazard ratio, 2.03; 95% CI, 1.45–2.84). As C1 increased, the risk for composite ACE (P < 0.001 for trend) and for coronary disease (P < 0.001 for trend) also increased. The hazard ratio and trend for cardiovascular-cause mortality were not significant. Conclusions This study showed that C1 of the radial pulse wave is correlated with cardiovascular events. Survival analysis showed that C1 value is an independent predictor of ACE and SCAD in asymptomatic patients with T2DM. Thus, screening for the first harmonic of the radial pulse may improve the risk stratification of cardiac events and SCAD in asymptomatic patients although they had no history of coronary artery disease or angina-related symptom.

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Significance of an Abnormal Ankle-Brachial Index in Patients With Established Coronary Artery Disease With and Without Associated Diabetes Mellitus

Cited by 12 publications

References 19 publications

Association Between Ankle-Brachial Index and Coronary Lesions Assessed by Coronary Angiography

Association Between Ankle-Brachial Index and Coronary Lesions Assessed by Coronary Angiography

Role of Low Ankle–Brachial Index in Cardiovascular and Mortality Risk Compared with Major Risk Conditions

The First Harmonic of Radial Pulse as an Early Predictor of Silent Coronary Artery Disease and Adverse Cardiac Events in Type 2 Diabetic Patients

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