Different Calculations of Ankle-Brachial Index and Their Impact on Cardiovascular Risk Prediction

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Abstract
Background— An ankle-brachial index (ABI; ratio of ankle and brachial systolic blood pressure) 1.5 were excluded. We compared patients with ABI with PAD , n=204 [25.0%]), those with ABI ≥0.9 according to the modified definition ( without PAD , n=524 [64.2%]), and those with ABI suspected PAD , n=88 [10.8%]). Follow-up data (median 6.6 years) were available for 812 patients (99.5%); 157 patients (19.3%) experienced cardiovascular events (cardiovascular death, myocardial infarction, or stroke). Patients without PAD had the lowest cardiovascular event rate, whereas event rates were comparable for patients with PAD and those with suspected PAD (14.8% versus 28.4% versus 25.0%, respectively). In a fully adjusted Cox regression analysis that included patients without PAD as the reference group, the hazard ratio (95% CI) was 1.56 (0.97 to 2.53) for patients with suspected PAD and 1.67 (1.16 to 2.40) for patients with PAD. Conclusions— When the higher ankle pressure is used for ABI calculation, a group of patients at high risk for cardiovascular events is overlooked. With a simple modification of ABI (use of the lower instead of the higher ankle pressure), more patients at risk could be identified.

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