Impact of Low Ankle-Brachial Index on the Risk of Recurrent Vascular Events Insights From the OPTIC Registry
Journal
Stroke
ISSN
0039-2499
1524-4628
Date Issued
2019
Author(s)
Halim Abboud
Linsay Monteiro Tavares
Julien Labreuche
Antonio Arauz
Alan Bryer
Ayrton Massaro
Mario Munoz Collazos
Philippe Gabriel Steg
Bassem I. Yamout
Eric Vicaut
Pierre Amarenco
Type
Resource Types::text::journal::journal article
URL Institutional Repository
Abstract
<jats:sec>
<jats:title>Background and Purpose—</jats:title>
<jats:p>Low ankle-brachial index (ABI) identifies a stroke subgroup with high risk of recurrent stroke, cardiovascular events, and death. However, limited data exist on the relationship between low ABI and stroke in low and middle-income countries. Therefore, we evaluated the prevalence of ABI ≤0.90 (which is diagnostic of peripheral artery disease) in nonembolic stroke patients or transient ischemic attack and assessed the correlation of low ABI with stroke risk, factors, and recurrent vascular events and death.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods—</jats:title>
<jats:p>Patients ≥45 years with acute transient ischemic attack or minor ischemic strokes were recruited consecutively from over 17 low-income and middle-income countries (Latin America [1543 patients], Middle East [1041 patients], North Africa [834 patients], and South Africa [217 patients]). The ABI measurement was performed at a single visit. Stroke recurrence and risk of new vascular events were assessed after 24 months of follow-up.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results—</jats:title>
<jats:p>
Among 3487 enrolled patients, abnormal ABI (<0.9) was present in 22.3 %. Patients with an ABI of ≤0.9 were more likely (
<jats:italic>P</jats:italic>
<0.05) to be male, older, and have a history of peripheral artery disease, hypertension, and diabetes mellitus. During 2-year follow-up, the rate of major cardiovascular event was higher in patients with ABI <0.9 than those with ABI ≥0.9 (Kaplan-Meier estimates, 22.5%; 95% CI, 19.6–25.8 versus 13.7%; 21.4–15.1;
<jats:italic>P</jats:italic>
<0.001), and when ABI was categorized into 4 groups (≤0.6; 95% CI, 0.6–0.9; 0.9–1; 1–1.4), the rate of major cardiovascular event was higher in those with ABI ≤0.6 than the other groups (Kaplan-Meier estimates, 32.6%; 95% CI, 21.0–48.3 for ABI≤0.6 versus 21.7%; 95% CI, 18.8–25.0 for ABI 0.6–0.9 versus 14.3%; 95% CI, 12.4–16.6 for ABI 0.9–1 versus 13.3%; 95% CI, 11.6–15.2 for ABI 1–1.4;
<jats:italic>P</jats:italic>
<0.001).
</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusions—</jats:title>
<jats:p>Among patients with nonembolic ischemic stroke or transient ischemic attack, those with low ABI had a higher rate of vascular events and death in this population. Screening for ABI in stroke patients may help identify patients at high risk of future events.</jats:p>
</jats:sec>
<jats:title>Background and Purpose—</jats:title>
<jats:p>Low ankle-brachial index (ABI) identifies a stroke subgroup with high risk of recurrent stroke, cardiovascular events, and death. However, limited data exist on the relationship between low ABI and stroke in low and middle-income countries. Therefore, we evaluated the prevalence of ABI ≤0.90 (which is diagnostic of peripheral artery disease) in nonembolic stroke patients or transient ischemic attack and assessed the correlation of low ABI with stroke risk, factors, and recurrent vascular events and death.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods—</jats:title>
<jats:p>Patients ≥45 years with acute transient ischemic attack or minor ischemic strokes were recruited consecutively from over 17 low-income and middle-income countries (Latin America [1543 patients], Middle East [1041 patients], North Africa [834 patients], and South Africa [217 patients]). The ABI measurement was performed at a single visit. Stroke recurrence and risk of new vascular events were assessed after 24 months of follow-up.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results—</jats:title>
<jats:p>
Among 3487 enrolled patients, abnormal ABI (<0.9) was present in 22.3 %. Patients with an ABI of ≤0.9 were more likely (
<jats:italic>P</jats:italic>
<0.05) to be male, older, and have a history of peripheral artery disease, hypertension, and diabetes mellitus. During 2-year follow-up, the rate of major cardiovascular event was higher in patients with ABI <0.9 than those with ABI ≥0.9 (Kaplan-Meier estimates, 22.5%; 95% CI, 19.6–25.8 versus 13.7%; 21.4–15.1;
<jats:italic>P</jats:italic>
<0.001), and when ABI was categorized into 4 groups (≤0.6; 95% CI, 0.6–0.9; 0.9–1; 1–1.4), the rate of major cardiovascular event was higher in those with ABI ≤0.6 than the other groups (Kaplan-Meier estimates, 32.6%; 95% CI, 21.0–48.3 for ABI≤0.6 versus 21.7%; 95% CI, 18.8–25.0 for ABI 0.6–0.9 versus 14.3%; 95% CI, 12.4–16.6 for ABI 0.9–1 versus 13.3%; 95% CI, 11.6–15.2 for ABI 1–1.4;
<jats:italic>P</jats:italic>
<0.001).
</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusions—</jats:title>
<jats:p>Among patients with nonembolic ischemic stroke or transient ischemic attack, those with low ABI had a higher rate of vascular events and death in this population. Screening for ABI in stroke patients may help identify patients at high risk of future events.</jats:p>
</jats:sec>
Subjects
ankle-brachial index
;
atherosclerosis
;
hypertension
;
prevalence
;
risk factors
;
age factors
;
aged
;
ankle brachial index
;
brain ischemia
;
female
;
humans
;
incidence
;
ischemic attack, transient
;
male
;
middle aged
;
peripheral arterial disease
;
prevalence
;
recurrence
;
registries
;
risk
;
sex factors
;
south africa
;
stroke
;
cholesterol
;
creatinine
;
glucose
;
high density lipoprotein cholesterol
;
low density lipoprotein cholesterol
;
triacylglycerol
;
adult
;
aged
;
ankle brachial index
;
article
;
body mass
;
brain ischemia
;
cardiovascular risk
;
cholesterol blood level
;
congestive heart failure
;
controlled study
;
coronary artery disease
;
creatinine blood level
;
diabetes mellitus
;
diastolic blood pressure
;
disease registry
;
dyslipidemia
;
employment status
;
female
;
follow up
;
glucose blood level
;
heart infarction
;
high density lipoprotein cholesterol level
;
hospital discharge
;
human
;
hypertension
;
low density lipoprotein cholesterol level
;
low income country
;
major clinical study
;
male
;
middle aged
;
middle east
;
middle income country
;
north africa
;
observational study
;
peripheral occlusive artery disease
;
practice guideline
;
priority journal
;
risk factor
;
rural area
;
socioeconomics
;
south africa
;
south and central america
;
stroke patient
;
systolic blood pressure
;
transient ischemic attack
;
triacylglycerol blood level
;
age
;
brain ischemia
;
cerebrovascular accident
;
incidence
;
peripheral occlusive artery disease
;
prevalence
;
recurrent disease
;
register
;
risk
;
sex factor
;
transient ischemic attack