Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May;38(3):372-381.
doi: 10.3904/kjim.2022.348. Epub 2023 Apr 20.

Influence of an abnormal ankle-brachial index on ischemic and bleeding events in patients undergoing percutaneous coronary intervention

Hangyul Kim  1 , Seung Do Lee  1 , Hyo Jin Lee  1 , Hye Ree Kim  1 , Kyehwan Kim  1 , Jin-Sin Koh  1 , Seok-Jae Hwang  1 , Jin-Yong Hwang  1 , Jong-Hwa Ahn  2 , Yongwhi Park  2 , Young-Hoon Jeong  3   4 , Jeong Rang Park  1 , Min Gyu Kang  1
Affiliations

Influence of an abnormal ankle-brachial index on ischemic and bleeding events in patients undergoing percutaneous coronary intervention

Hangyul Kim et al. Korean J Intern Med. 2023 May.

Abstract

Background/aims: Bleeding events after percutaneous coronary intervention (PCI) have important prognostic implications. Data on the influence of an abnormal ankle-brachial index (ABI) on both ischemic and bleeding events in patients undergoing PCI are limited.

Methods: We included patients who underwent PCI with available ABI data (abnormal ABI, ≤ 0.9 or > 1.4). The primary endpoint was the composite of all-cause death, myocardial infarction (MI), stroke, and major bleeding.

Results: Among 4,747 patients, an abnormal ABI was observed in 610 patients (12.9%). During follow-up (median, 31 months), the 5-year cumulative incidence of adverse clinical events was higher in the abnormal ABI group than in the normal ABI group: primary endpoint (36.0% vs. 14.5%, log-rank test, p < 0.001); all-cause death (19.4% vs. 5.1%, log-rank test, p < 0.001); MI (6.3% vs. 4.1%, log-rank test, p = 0.013); stroke (6.2% vs. 2.7%, log-rank test, p = 0.001); and major bleeding (8.9% vs. 3.7%, log-rank test, p < 0.001). An abnormal ABI was an independent risk factor for all-cause death (hazard ratio [HR], 3.05; p < 0.001), stroke (HR, 1.79; p = 0.042), and major bleeding (HR, 1.61; p = 0.034).

Conclusion: An abnormal ABI is a risk factor for both ischemic and bleeding events after PCI. Our study findings may be helpful in determining the optimal method for secondary prevention after PCI.

Keywords: Ankle-brachial index; Bleeding event; Ischemic event; Percutaneous coronary intervention; Peripheral artery disease.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest

The authors disclose no conflicts.

Figures

Figure 1.
Figure 1.
Flow diagram of the study. Patients who underwent percutaneous coronary intervention (PCI) were eligible for this study. GNUH, Gyeongsang National University Hospital; PAD, peripheral artery disease; ABI, ankle-brachial index.
Figure 2.
Figure 2.
Five-year cumulative incidence of the clinical outcomes. (A) Primary endpoint: composite of all-cause death, myocardial infarction, stroke, and major bleeding. (B) All-cause death. (C) Myocardial infarction. (D) Stroke. (E) Major bleeding. ABI, ankle-brachial index.
Figure 3.
Figure 3.
Predictive discrimination model for primary endpoint and major bleeding. (A) Primary endpoint. (B) Major bleeding. AUC, area under curve; CI, confidence interval; ABI, ankle-brachial index. *Age > 65 years, diabetes, acute coronary syndrome, previous percutaneous coronary intervention, left ventricle ejection fraction < 50%, renal dysfunction (estimated glomerular filtration rate [eGFR] < 60 mL/ min/1.73 m2), and anemia (hemoglobin < 13 g/dL in men, < 12 g/dL in women). †Dyslipidemia, renal dysfunction (eGFR < 60 mL/min/1.73 m2), and anemia (hemoglobin < 13 g/dL in men, < 12 g/dL in women).
None
See this image and copyright information in PMC

Comment in

References

    1. Fowkes FG, Aboyans V, Fowkes FJ, McDermott MM, Sampson UK, Criqui MH. Peripheral artery disease: epidemiology and global perspectives. Nat Rev Cardiol. 2017;14:156–170. - PubMed
    1. Eagle KA, Rihal CS, Foster ED, Mickel MC, Gersh BJ. Long-term survival in patients with coronary artery disease: importance of peripheral vascular disease. The coronary artery surgery study (CASS) investigators. J Am Coll Cardiol. 1994;23:1091–1095. - PubMed
    1. Bhatt DL, Peterson ED, Harrington RA, et al. Prior polyvascular disease: risk factor for adverse ischaemic outcomes in acute coronary syndromes. Eur Heart J. 2009;30:1195–1202. - PubMed
    1. Gerhard-Herman MD, Gornik HL, Barrett C, 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. Bevan GH, White Solaru KT. Evidence-based medical management of peripheral artery disease. Arterioscler Thromb Vasc Biol. 2020;40:541–553. - PubMed

MeSH terms