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. 2022 Jul 1;29(7):992-1000.
doi: 10.5551/jat.62998. Epub 2021 Jul 22.

Association of Asymptomatic Low Ankle-Brachial Index with Long-Term Clinical Outcomes in Patients after Acute Myocardial Infarction

Soichiro Ban  1 , Kenichi Sakakura  1 , Hiroyuki Jinnouchi  1 , Yousuke Taniguchi  1 , Takunori Tsukui  1 , Yusuke Watanabe  1 , Kei Yamamoto  1 , Masaru Seguchi  1 , Hiroshi Wada  1 , Hideo Fujita  1
Affiliations

Association of Asymptomatic Low Ankle-Brachial Index with Long-Term Clinical Outcomes in Patients after Acute Myocardial Infarction

Soichiro Ban et al. J Atheroscler Thromb. .

Abstract

Aims: Peripheral arterial disease (PAD) is the well-known risk factor for cardiovascular events. Although low ankle-brachial index (ABI) is recognized as a risk factor in general population, low ABI without any symptoms of PAD has not been established as a prognostic marker in patients with acute myocardial infarction (AMI) yet. The purpose of this retrospective study was to examine whether asymptomatic low ABI was associated with long-term clinical outcomes in AMI patients without treatment history of PAD.

Methods: We included 850 AMI patients without a history of PAD and divided them into the preserved ABI (ABI ≥ 0.9) group (n=760) and the reduced ABI (ABI ＜0.9) group (n=90) on the basis of the ABI measurement during the hospitalization. The primary endpoint was the major adverse cardiovascular events (MACE) defined as the composite of all-cause death, non-fatal myocardial infarction, and hospitalization for heart failure.

Results: During the median follow-up duration of 497 days (Q1: 219 days to Q3: 929 days), a total of 152 MACE were observed. The Kaplan-Meier curves showed that MACE were more frequently observed in the reduced ABI group than in the preserved ABI group (p＜0.001). The multivariate COX hazard analysis revealed that reduced ABI was significantly associated with MACE (hazard ratio 2.046, 95% confidence interval 1.344-3.144, p=0.001) after controlling confounding factors.

Conclusions: Reduced ABI was significantly associated with long-term adverse events in AMI patients without a history of PAD. Our results suggest the usefulness of ABI as a prognostic marker in AMI patients irrespective of symptomatic PAD.

Keywords: Acute myocardial infarction; Ankle–brachial index; Peripheral artery disease.

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Figures

Fig.1. Study flowchart
Fig.1. Study flowchart
Abbreviations: AMI=acute myocardial infarction, ABI=ankle–brachial index, PAD=peripheral arterial disease, CABG=coronary artery bypass graft surgery.
Fig.2. Kaplan–Meier curves for MACE-free survival between the reduced ABI group and the preserved ABI group
Fig.2. Kaplan–Meier curves for MACE-free survival between the reduced ABI group and the preserved ABI group
A log-rank test was used.
See this image and copyright information in PMC

Comment in

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