Abstract 1643: Prognostic Value of Ankle Brachial Index in Asymptomatic Peripheral Arterial Disease Patients With Prior Coronary or Cerebrovascular Disease
Purpose Ankle brachial index (ABI) is an important prognostic predictor in population-based studies, but there is limited information in patients with prior coronary artery (CAD) or cerebrovascular disease (CVD).
Patients and Methods The prospective cohort MERITO II study enrolled 1096 patients [mean age 73.6 (SD 5.4); men 65%] with CAD (55%), CVD (38%) or CAD and CVD (7%), and no history of peripheral arterial disease (PAD), followed for about 1 year. The prevalence of PAD detected by a value of ABI less than 0.9 was 30%. In addition, ABI was greater than 1.4 in 7% of patients. We analyzed the prognostic predictive value of asymptomatic (PAD) detected by ABI measurement adjusted for demographic, clinical, biological and ECG baseline variables in the Cox proportional hazards model. The primary outcome was a composite of cardiovascular (CV) death, nonfatal acute coronary syndrome (ACS), nonfatal CVD or vascular interventions.
Results ABI <0.9 was a relevant predictor of the primary composite endpoint after adjustment for age, gender, arterial territory, diabetes, smoking status, LDL value, renal dysfunction, left ventricular hypertrophy, and baseline treatment. By contrast, ABI >1.4 was not a significant prognostic predictor.
Conclusions Asymptomatic PAD detected by ABI measurement in patients with prior CAD or CVD identified a subgroup of very high risk independently of other predictors. ABI should be measured routinely in patients with CAD or CVD and no history of PAD.