Abstract
Objectives: The Ankle-Brachial index (ABI) is a highly effective tool for diagnosing peripheral artery disease. Peripheral arterial disease (PAD) is frequently under-diagnosed condition in the clinical setup which leads to a lack of opportunity in detection of subjects at a high risk for cardiovascular (CV) death. But use of the Ankle-Brachial index (ABI) till date has not been validated for the diagnosis of coronary artery disease.
Aim of this Study: To evaluate the ability of the ankle-brachial index in prediction of coronary artery disease in patients undergoing coronary angiography.
Methods: Patients with clinical suspicion of coronary artery disease and indication for coronary angiography were prospectively evaluated. Significant coronary artery disease was defined as the presence of stenosis >70% of at least one of the major epicardial coronary artery or any of their major branches. A ROC curve was developed to define the ankle-brachial index cutoff that best predicts coronary artery disease.
Results: A total of 51 patients were evaluated: mean age was 56 ± 12 years and 55% of them were males. Ninteen (37.2%) patients had significant coronary disease. Ankle-brachial index measurement in these patients was significantly lower than in those without coronary artery disease (0.78 ± 0.14 vs. 0.86 ± 0.87; p <0 .01). Ankle-brachial index <0.87 showed a sensitivity of 31%, specificity of 96.4%, positive predictive value of 76.9% and negative predictive value of 71.6%. The area under the receiver operating characteristic (ROC) curve was 0.73 (95% confidence interval of 0.67-0.79).
Conclusions: ABI values ≤ 0.87 showed high specificity to predict significant coronary artery disease.
Keywords: Atherosclerosis. Cardiovascular diseases. Ankle brachial index. Risk factors. Coronary angiography, receiver operating characteristic (ROC) curve.
References
- Ness J, Aronow WS. Prevalence of coexistence of coronary artery disease, ischemic stroke, and peripheral arterial disease in older persons, mean age 80 years, in an academic hospital based geriatrics practice. J Am Geriatr Soc. 1999;47(10): 1255-6.
- Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, et al. ACC/ AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; Trans Atlantic Inter-Society Consensus; and Vascular Disease Foundation. Circulation. 2006;113(11):e463-654.
- Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, et al. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina-summary article: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on the Management of Patients With Chronic Stable Angina). J Am Coll Cardiol. 2003;41(1):159-68.
- Feigelson HS, Criqui MH, Fronek A, Langer RD, Molgaard CA. Screening for peripheral arterial disease: the sensitivity, specificity, and predictive value of noninvasive tests in a defined population. Am J Epidemiol 1994; 140:526–34.
- White C. Clinical practice: intermittent claudication. N Engl J Med. 2007;356 (12): 1241-50.
- Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG; TASC II Working Group. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg. 2007;45 Suppl S:S5-67.
- Newman AB, Shemanski L, Manolio TA, Cushman M, Mittelmark M, Polak JF, et al. Ankle-arm index as a predictor of cardiovascular disease and mortality in the Cardiovascular Health Study. The Cardio-vascular Health Study Group. Arterioscler Thromb Vasc Biol. 1999;19(3):538-45.
- Norman PE, Davis WA, Bruce DG, Davis TM. Peripheral arterial disease and risk of cardiac death in type 2 diabetes: the Fremantle Diabetes Study. Diabetes Care. 2006;29(3):575-80.
- Papa ED, Helber I, Ehrlichmann MR, Alves CM, Makdisse M, Matos LN, et al. Ankle-brachial index as a predictor of coronary disease events in elderly patients submitted to coronary angiography. Clinics (São Paulo). 2013;68(12):1481-7.
- Aronow WS, Ahn C. Prevalence of coexistence of coronary artery disease, peripheral arterial disease, and atherothrombotic brain infarction in men and women > or = 62 years of age. Am J Cardiol. 1994;74(1):64-5.
- Lee AJ, Price JF, Russell MJ, Smith FB, van Wijk MC, Fowkes FG. Improved prediction of fatal myocardial infarction using the ankle brachial index in addition to conventional risk factors: the Edinburgh Artery Study. Circulation. 2004;110(19):3075-80.
- Otah KE, Madan A, Otah E, Badero O, Clark LT, Salifu MO. Usefulness of an abnormal ankle-brachial index to predict presence of coronary artery disease in African-Americans. Am J Cardiol. 2004;93(4):481-3
- Marcelo sabedotti, Rogerio sarmento, Aleaxander D .ABI as predictor of CAI. Rev Bras cardiol invasiva 2014;22(4):359-63.
Corresponding Author
Dr Rajiv Girdhar
Assistant Professor in Cardiology Department in Rajarajeswari Medical College and Hospital, Bangalore
DOI: https://dx.doi.org/10.18535/jmscr/v8i5.61
