Open AccessClinical Characteristics and Outcomes of Patients with High Ankle-Brachial Index from the IMPACT-ABI Study
Author(s) -
Hitoshi Nishimura,
Takashi Miura,
Masatoshi Minamisawa,
Yasushi Ueki,
Naoyuki Abe,
Naoto Hashizume,
Tomoaki Mochidome,
Mikiko Harada,
Kunihiko Shimizu,
Wataru Shoin,
Koji Yoshie,
Yasutaka Oguchi,
Soichiro Ebisawa,
Hirohiko Motoki,
Atsushi Izawa,
Jun Koyama,
Uichi Ikeda,
Koichiro Kuwahara
Publication year - 2016
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0167150
Subject(s) - medicine , hazard ratio , mace , odds ratio , body mass index , hemodialysis , kidney disease , cohort study , cumulative incidence , proportional hazards model , confidence interval , retrospective cohort study , myocardial infarction , cohort , percutaneous coronary intervention
Background Reduced ankle–brachial index (ABI) is a predictor of cardiovascular events. However, the significance of high ABI remains poorly understood. This study aimed to assess the characteristics and outcomes of patients with high ABI. Methods The IMPACT-ABI study was a retrospective cohort study that enrolled and examined ABI in 3,131 patients hospitalized for cardiovascular disease between January 2005 and December 2012. From this cohort, 2,419 patients were identified and stratified into two groups: high ABI (> 1.4; 2.6%) and normal ABI (1.0–1.4; 97.3%). The primary endpoint was the cumulative incidence of major adverse cardiovascular events (MACE), including cardiovascular-associated death, myocardial infarction, and stroke. Results Compared with the normal ABI group, patients in the high ABI group showed significantly lower body mass index (BMI) and hemoglobin level, but had higher incidence of chronic kidney disease and hemodialysis. Multivariate logistic regression analysis revealed that hemodialysis was the strongest predictor of high ABI (odds ratio, 6.18; 95% confidence interval (CI), 3.05–12.52; P < 0.001). During the follow-up (median, 4.7 years), 172 cases of MACE occurred. Cumulative MACE incidence in patients with high ABI was significantly increased compared to that in those with normal ABI (32.5% vs. 14.5%; P = 0.005). In traditional cardiovascular risk factors-adjusted multivariate Cox proportional hazard analysis, high ABI was an independent predictor of MACE (hazard ratio, 2.07; 95% CI, 1.02–4.20; P = 0.044). Conclusion Lower BMI, chronic kidney disease, and hemodialysis are more frequent in patients with high ABI. Hemodialysis is the strongest predictor of high ABI. High ABI is a parameter that independently predicts MACE.