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Alternative ankle-brachial index method identifies additional at-risk individuals
Kevin T Nead1, John P Cooke, Jeffrey W Olin
1Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
Journal of the American College of Cardiology
|May 28, 2013
Summary
An alternative ankle-brachial index (ABI) calculation method better predicts mortality risk than traditional methods. This improved diagnostic approach identifies individuals at increased risk for death, including those missed by current protocols.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- The ankle-brachial index (ABI) is crucial for diagnosing peripheral arterial disease (PAD) and assessing cardiovascular event risk.
- Traditional ABI calculation uses the higher ankle pressure, but studies comparing methods are limited.
Purpose of the Study:
- To evaluate if an alternative ABI calculation method enhances mortality risk prediction compared to traditional approaches.
- To identify individuals at increased risk for mortality who may be missed by current ABI protocols.
Main Methods:
- 1,413 participants undergoing coronary angiography had their ABI calculated using traditional and alternative methods.
- Peripheral arterial disease (PAD) was defined as ABI <0.90 using the traditional method or the lower ankle pressure in the alternative method.
- Participants were followed for all-cause and cardiovascular mortality.
Main Results:
- The alternative PAD group showed significantly increased risks for all-cause (HR: 1.49) and cardiovascular mortality (HR: 3.21) compared to the no-PAD group.
- A higher difference in brachial systolic pressures also correlated with increased all-cause mortality risk in the no-PAD group (HR: 1.11 per 1-mm Hg).
Conclusions:
- An alternative ABI method, alongside brachial pressure differences, identifies individuals at elevated mortality risk missed by traditional ABI.
- Current ABI protocols may require re-evaluation to improve patient risk stratification and outcomes.
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