The coexistence of peripheral artery disease in patients with coronary artery disease (CAD) has been associated with a poor cardiovascular outcome. The aim of this study was to assess the usefulness of ankle-brachial index (ABI) assessment in predicting the severity of coronary artery disease in patients with acute myocardial infraction (AMI).
We studied 101 patients [77.2% male; mean age 60.9 years; 63.4% hypertensives; 24.8% with diabetes mellitus (DM)] who were hospitalized because of ST-elevation MI (STEMI, 51.5%) and Non-ST–elevation MI (NSTEMI). All patients underwent baseline estimation of clinical and laboratory parameters during their hospitalization. The ABI was measured according to established methodology using a certified automated device and abnormal ABI was defined as a value <0.9. Severity of CAD was estimated by the number of affected main vessels.
In the entire population, mean ABI was 1.11 ± 0.19, while 15.8% of patients had abnormal ABI. NSTEMI patients compared to those with STEMI demonstrated relatively lower ABI (1.07 ± 0.18 vs 1.12 ± 0.16; p = 0.144) and had more often abnormal ABI (22.4% vs 9.6%; p = 0.103). Using univariate analysis in the entire population, severity of CAD was correlated with age (r = 0.133; p = 0.053), history of DM (r = 0.225; p = 0.01), abnormal ABI (r = 0.242; p = 0.015) and ABI value (r = 0.214; p = 0.029). In multivariate regression models, both ABI value (b = 0.212; p = 0.037) and abnormal ABI (b = 0.224; p = 0.036) remained significant predictors of CAD severity independently of gender, age, DM, smoking, low density lipoprotein (LDL-C), 24-h systolic BP and the type of MI.
Estimation of ABI managed to predict multivessel CAD in patients with AMI. These findings in patients with ACS scheduled to undergo a cardiac catheterization may raise the suspicion of advanced disease, alerting the need for more aggressive diagnostic and therapeutic strategies.
First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, GREECE