The Cardiovascular-Mortality-Based Estimate for Normal Range of the Ankle-Brachial Index (ABI)

doi:10.3390/jcdd9050147

. 2022 May 5;9(5):147.

doi: 10.3390/jcdd9050147.

The Cardiovascular-Mortality-Based Estimate for Normal Range of the Ankle-Brachial Index (ABI)

Essi Peltonen¹, Mirjami Laivuori², Damir Vakhitov³, Päivi Korhonen⁴, Maarit Venermo², Harri Hakovirta^{1

5}

Affiliations

¹ Department of Surgery, University of Turku, 20500 Turku, Finland.
² Department of Vascular Surgery, Abdominal Center, Helsinki University Hospital and University of Helsinki, 00100 Helsinki, Finland.
³ Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, 33520 Tampere, Finland.
⁴ Department of General Practice, University of Turku, 20500 Turku, Finland.
⁵ Department of Surgery, Satasairaala, 28500 Pori, Finland.

PMID: 35621858
PMCID: PMC9144270
DOI: 10.3390/jcdd9050147

The Cardiovascular-Mortality-Based Estimate for Normal Range of the Ankle-Brachial Index (ABI)

Essi Peltonen et al. J Cardiovasc Dev Dis. 2022.

. 2022 May 5;9(5):147.

doi: 10.3390/jcdd9050147.

Authors

Essi Peltonen¹, Mirjami Laivuori², Damir Vakhitov³, Päivi Korhonen⁴, Maarit Venermo², Harri Hakovirta^{1

5}

Affiliations

¹ Department of Surgery, University of Turku, 20500 Turku, Finland.
² Department of Vascular Surgery, Abdominal Center, Helsinki University Hospital and University of Helsinki, 00100 Helsinki, Finland.
³ Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, 33520 Tampere, Finland.
⁴ Department of General Practice, University of Turku, 20500 Turku, Finland.
⁵ Department of Surgery, Satasairaala, 28500 Pori, Finland.

PMID: 35621858
PMCID: PMC9144270
DOI: 10.3390/jcdd9050147

Abstract

Background: The ankle−brachial index (ABI) is a first-line examination in cardiovascular risk evaluation. Since cut-off values for normal ABI vary, the aim of the present study was to identify the cardiovascular-mortality-based estimate for the normal range of the ABI. After determining the reference range for the ABI, the corresponding toe−brachial index (TBI) and toe pressure for normal ABI were analyzed. Methods: All consecutive non-invasive pressure measurements in the vascular laboratory of a large university hospital 2011−2013 inclusive were collected and combined with patient characteristics and official dates and causes of death. Patients with an ABI range of 0.8−1.4 on both lower limbs were included in this study. Results: From 2751 patients, 868 had bilateral ABI values within the inclusion. Both ABI category ranges 0.80−0.89 and 0.90−0.99 had poorer survival compared to ABI categories 1.00−1.29 (p < 0.05). The 1-, 3-, and 5-year cardiovascular-death-free survival for respective ABI categories 0.80−0.99 vs. 1.00−1.29 were 90% vs. 96%, 84% vs. 92%, and 60% vs. 87%. The 1-, 3-, and 5-year overall survival for ABI categories 0.80−0.99 vs. 1.00−1.29 were 85% vs. 92%, 75% vs. 83%, and 42% vs. 74%. Conclusions: Borderline ABI (0.90−0.99) associates with higher overall and cardiovascular mortality compared to ABI values 1.00−1.29.

Keywords: ABI; TBI; cardiovascular; mortality; survival.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Figure 1**
Flow chart of the study. Patients with bilateral ankle–brachial index (ABI) 0.80–1.40 were included in the initial survival analysis.

**Figure 2**
A-B Kaplan–Meier curves for 8-year survival for ABI 0.80–1.40. Panel (A), overall survival; (B), cardiovascular-death-free survival.

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References

1. Roth G.A., Mensah G.A., Johnson C.O., Addolorato G., Ammirati E., Baddour L.M., Barengo N.C., Beaton A.Z., Benjamin E.J., Benziger C.P., et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019: Update from the GBD 2019 Study. J. Am. Coll. Cardiol. 2020;76:2982–3021. doi: 10.1016/j.jacc.2020.11.010. - DOI - PMC - PubMed
1. Aboyans V., Ricco J.B., Bartelink M.E.L., Bjorck M., Brodmann M., Cohnert T. Editor’s Choice-2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS) Eur. J. Vasc. Endovasc. Surg. 2018;55:305–368. doi: 10.1016/j.ejvs.2017.07.018. - DOI - PubMed
1. Aboyans V., Criqui M.H., Abraham P., Allison M.A., Creager M.A., Diehm C., Fowkes F.G.R., Hiatt W.R., Jönsson B., Lacroix P., et al. Measurement and interpretation of the ankle-brachial index: A scientific statement from the American Heart Association. Circulation. 2012;126:2890–2909. doi: 10.1161/CIR.0b013e318276fbcb. - DOI - PubMed
1. Gerhard-Herman M.D., Gornik H.L., Barrett C., Barshes N.R., Corriere M.A., Drachman D.E., Fleisher L.A., Fowkes F.G.R., Hamburg N.M., Kinlay S., et al. 2016 AHA/ACC Guideline on the Management of Patients with Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017;135:e726–e779. - PMC - PubMed
1. Norgren L., Hiatt W.R., Dormandy J.A., Nehler M.R., Harris K.A., Fowkes F.G.R. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) J. Vasc. Surg. 2007;45:S5–S67. doi: 10.1016/j.jvs.2006.12.037. - DOI - PubMed

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[1] Roth G.A., Mensah G.A., Johnson C.O., Addolorato G., Ammirati E., Baddour L.M., Barengo N.C., Beaton A.Z., Benjamin E.J., Benziger C.P., et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019: Update from the GBD 2019 Study. J. Am. Coll. Cardiol. 2020;76:2982–3021. doi: 10.1016/j.jacc.2020.11.010. - DOI - PMC - PubMed

[2] Roth G.A., Mensah G.A., Johnson C.O., Addolorato G., Ammirati E., Baddour L.M., Barengo N.C., Beaton A.Z., Benjamin E.J., Benziger C.P., et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019: Update from the GBD 2019 Study. J. Am. Coll. Cardiol. 2020;76:2982–3021. doi: 10.1016/j.jacc.2020.11.010. - DOI - PMC - PubMed

[3] Aboyans V., Ricco J.B., Bartelink M.E.L., Bjorck M., Brodmann M., Cohnert T. Editor’s Choice-2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS) Eur. J. Vasc. Endovasc. Surg. 2018;55:305–368. doi: 10.1016/j.ejvs.2017.07.018. - DOI - PubMed

[4] Aboyans V., Ricco J.B., Bartelink M.E.L., Bjorck M., Brodmann M., Cohnert T. Editor’s Choice-2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS) Eur. J. Vasc. Endovasc. Surg. 2018;55:305–368. doi: 10.1016/j.ejvs.2017.07.018. - DOI - PubMed

[5] Aboyans V., Criqui M.H., Abraham P., Allison M.A., Creager M.A., Diehm C., Fowkes F.G.R., Hiatt W.R., Jönsson B., Lacroix P., et al. Measurement and interpretation of the ankle-brachial index: A scientific statement from the American Heart Association. Circulation. 2012;126:2890–2909. doi: 10.1161/CIR.0b013e318276fbcb. - DOI - PubMed

[6] Aboyans V., Criqui M.H., Abraham P., Allison M.A., Creager M.A., Diehm C., Fowkes F.G.R., Hiatt W.R., Jönsson B., Lacroix P., et al. Measurement and interpretation of the ankle-brachial index: A scientific statement from the American Heart Association. Circulation. 2012;126:2890–2909. doi: 10.1161/CIR.0b013e318276fbcb. - DOI - PubMed

[7] Gerhard-Herman M.D., Gornik H.L., Barrett C., Barshes N.R., Corriere M.A., Drachman D.E., Fleisher L.A., Fowkes F.G.R., Hamburg N.M., Kinlay S., et al. 2016 AHA/ACC Guideline on the Management of Patients with Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017;135:e726–e779. - PMC - PubMed

[8] Gerhard-Herman M.D., Gornik H.L., Barrett C., Barshes N.R., Corriere M.A., Drachman D.E., Fleisher L.A., Fowkes F.G.R., Hamburg N.M., Kinlay S., et al. 2016 AHA/ACC Guideline on the Management of Patients with Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017;135:e726–e779. - PMC - PubMed

[9] Norgren L., Hiatt W.R., Dormandy J.A., Nehler M.R., Harris K.A., Fowkes F.G.R. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) J. Vasc. Surg. 2007;45:S5–S67. doi: 10.1016/j.jvs.2006.12.037. - DOI - PubMed

[10] Norgren L., Hiatt W.R., Dormandy J.A., Nehler M.R., Harris K.A., Fowkes F.G.R. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) J. Vasc. Surg. 2007;45:S5–S67. doi: 10.1016/j.jvs.2006.12.037. - DOI - PubMed

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The Cardiovascular-Mortality-Based Estimate for Normal Range of the Ankle-Brachial Index (ABI)

Affiliations

The Cardiovascular-Mortality-Based Estimate for Normal Range of the Ankle-Brachial Index (ABI)

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

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References

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