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Combination of low ankle-brachial index and high ankle-brachial index difference for mortality prediction
Wei-Chung Tsai1,2,3, Wen-Hsien Lee1,2,3,4, Ying-Chih Chen2,4
1Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Insights
A new ABI score combining low ankle-brachial index (ABI) and high ABI difference (ABID) significantly predicts patient mortality. This combined ABI score offers superior prognostic value compared to individual measures for cardiovascular and overall deaths.
Area of Science:
- Cardiovascular Medicine
- Diagnostic Imaging
- Prognostic Biomarkers
Background:
- Low ankle-brachial index (ABI) and high ABI difference (ABID) are independently linked to adverse patient outcomes.
- Previous research has not evaluated the combined predictive power of low ABI and high ABID for survival.
- Peripheral artery disease assessment is crucial for cardiovascular risk stratification.
Purpose of the Study:
- To develop and validate a novel ABI score integrating low ABI and high ABID.
- To assess the efficacy of this combined ABI score in predicting all-cause and cardiovascular mortality.
- To compare the predictive performance of the ABI score against individual ABI and ABID measures.
Main Methods:
- A cohort of 941 patients undergoing echocardiography was included.
- Ankle-brachial index (ABI) was measured using an ABI-form device; ABI difference (ABID) was calculated as |right ABI - left ABI|.
- An ABI score was created: 1 point for ABI < 0.9 and 1 point for ABID ≥ 0.17. Survival analysis and multivariable models were employed.
Main Results:
- The prevalence of ABI < 0.9 and ABID ≥ 0.17 was 6.1% and 6.8%, respectively.
- Over a median follow-up of 93 months, 228 overall deaths and 87 cardiovascular deaths occurred.
- The ABI score, along with individual ABI and ABID parameters, significantly predicted mortality (P ≤ 0.009).
- The ABI score demonstrated superior predictive ability for overall and cardiovascular mortality compared to other ABI-related models (P ≤ 0.049).
Conclusions:
- The developed ABI score, combining low ABI and high ABID, is a potent predictor of patient mortality.
- Incorporating this ABI score into clinical practice can enhance cardiovascular risk assessment and patient prognostication.
- Routine calculation of the ABI score is recommended for improved mortality prediction in clinical settings.
Abstract:
Low ankle-brachial index (ABI) and high ABI difference (ABID) are each associated with poor prognosis. No study has assessed the ability of the combination of low ABI and high ABID to predict survival. We created an ABI score by assigning 1 point for ABI < 0.9 and 1 point for ABID ≥ 0.17 and examine the ability of this ABI score to predict mortality. We included 941 patients scheduled for echocardiographic examination. The ABI was measured using an ABI-form device. ABID was calculated as |right ABI-left ABI|. Among the 941 subjects, the prevalence of ABI < 0.9 and ABID ≥ 0.17 was 6.1% and 6.8%, respectively. Median follow-up to mortality was 93 months. There were 87 cardiovascular and 228 overall deaths. All ABI-related parameters, including ABI, ABID, ABI < 0.9, ABID ≥ 0.17, and ABI score, were significantly associated with overall and cardiovascular mortality in the multivariable analysis (P ≤ 0.009). Further, in the direct comparison of multivariable models, the basic model + ABI score was the best at predicting overall and cardiovascular mortality among the five ABI-related multivariable models (P ≤ 0.049). Hence, the ABI score, a combination of ABI < 0.9 and ABID ≥ 0.17, should be calculated for better mortality prediction.
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