Peripheral artery disease, abnormal ankle-brachial index and prognosis after acute coronary syndrome
2Sackler School of Medicine, Tel-Aviv University, Israel
3Division of Cardiology, Rabin Medical Center, Israel
4Department of Cardiology, Yitzhak Shamir Medical Center, Israel
5Department of Cardiology, Galilee Medical Center, Nahariya, affiliated to Azrieli Faculty of Medicine, Bar-Ilan University of the Galilee, Safed, Israel
6Department of Cardiology, Soroka University Medical Center Affiliated to the Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
7Integrated Heart Center, Shaare Zedek Medical Center, Israel
Background: Ankle-brachial index (ABI) is independent prognostic marker of cardiovascular events among patients with coronary artery disease (CAD). There are only few data regarding the significance of ABI in patients with acute coronary syndrome (ACS). We aimed to investigate the outcome of patients hospitalized with ACS and abnormal ABI.
Methods: We investigated 1,047 patients who were hospitalized due to ACS. ABI was prospectively measured during index hospitalization. Patients were stratified to those with clinical peripheral artery disease (PAD) (N=132), without clinical PAD but with abnormal (<0.9) ABI (“sub-clinical PAD”; N=148) and patients without clinical PAD and with normal ABI (“no PAD”; N=767). Patients were prospectively followed for 30-day MACE (Re-ACS, urgent revascularization, stroke and mortality) and 1-year all-cause mortality.
Results: Mean age of the study population was 64 of whom 20% were women. There were gradual and significant increase through the 3 study groups (no-PAD, sub-clinical PAD to clinical PAD) in patient`s age, incidence of prior stroke events, diabetes mellitus and hypertension (p for trend =0.001 for all). With respect to in-hospital course the 3 study groups showed gradual increase in the incidence of complicated in-hospital course with increase in heart failure [2.5%, 6.1%, and 9.2% (p for trend= 0.001)], acute kidney injury [ 2%,4.1% and 11.5%, (p for trend= 0.001)]. At 30-days follow up there was stepwise increase in MACE rate such that patients with no evidence of PAD had the lowest rate followed by sub-clinical PAD and clinical PAD (3.5%, 6.8%, 8.1%, p for trend = 0.009). Likewise, there was significant increase in 1-year mortality from 3.4% in patients without PAD, through 6.8% in patients with sub-clinical PAD to 15.2% in patients with clinical PAD (p for trend = 0.001).
Conclusions: sub-clinical PAD is associated with poor outcome among patients with ACS, suggesting that ABI should be used as a routine screening among patients with ACS, regardless of PAD symptoms.
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