Ankle-brachial index and cardiovascular outcomes in the Bypass Angioplasty Revascularization Investigation 2 Diabetes trial

• Published in: The American heart journal Vol. 164; no. 4; pp. 585 - 590.e4
• Main Authors: Abbott, J. Dawn, MD, Lombardero, Manuel S., MS, Barsness, Gregory W., MD, Pena-Sing, Ivan, MD, Buitrón, L. Virginia, MD, Singh, Premranjan, MD, Woodhead, Gail, RN, Tardif, Jean-Claude, MD, Kelsey, Sheryl F., PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2012; Mosby; Elsevier Limited
• Subjects: Angioplasty; Ankle Brachial Index; Biological and medical sciences; Blood pressure; Body mass index; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Cause of Death; Colleges & universities; Coronary Artery Disease - complications; Coronary Artery Disease - mortality; Diabetes; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - mortality; Diabetes. Impaired glucose tolerance; Diabetic Angiopathies - complications; Diabetic Angiopathies - mortality; Diseases of the cardiovascular system; Drug therapy; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Heart attacks; Heart failure; Humans; Hypertension; Insulin; Kinases; Male; Medical sciences; Middle Aged; Mortality; Myocardial Infarction - etiology; Myocardial Infarction - mortality; Older people; Peripheral Vascular Diseases - complications; Peripheral Vascular Diseases - mortality; Prognosis; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Risk; Stroke; Stroke - etiology; Stroke - mortality; Survival Rate; Pittsburgh Pennsylvania; Endocrinopathy; Prognosis; Angioplasty; Diabetes mellitus; Instrumentation therapy; Instrumental dilatation; Index; Ankle; Bypass; Surgery; Circulatory system; Cardiology; Revascularization
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2012.06.017

Background Peripheral arterial disease increases cardiovascular risk in many patient populations. The risks associated with an abnormal ankle-brachial index (ABI) in patients with type 2 diabetes and stable coronary artery disease have not been well described with respect to thresholds and types of cardiovascular events. Methods We examined 2,368 patients in the BARI 2D trial who underwent ABI assessment at baseline. Death and major cardiovascular events (death, myocardial infarction and stroke) during follow-up (average 4.3 years) were assessed across the ABI spectrum and by categorized ABI: low (≤0.90), normal (0.91-1.3), high (>1.3), or noncompressible. Results A total of 12,568 person-years were available for mortality analysis. During follow-up, 316 patients died, and 549 had major cardiovascular events. After adjustment for potential confounders, with normal ABI as the referent group, a low ABI conferred an increased risk of death (relative risk [RR] 1.6, CI 1.2-2.2, P = .0005) and major cardiovascular events (RR 1.4, CI 1.1-1.7, P = .004). Patients with a high ABI had similar outcomes as patients with a normal ABI, but risk again increased in patients with a noncompressible ABI with a risk of death (RR 1.9, CI 1.3-2.8, P = .001) and major cardiovascular event (RR 1.5, CI 1.1-2.1, P = .01). Conclusions In patients with coronary artery disease and type 2 diabetes, ABI screening and identification of ABI abnormalities including a low ABI (<1.0) or noncompressible artery provide incremental prognostic information.