Associations of ankle-brachial index (ABI) with cerebral arterial disease and vascular events following ischemic stroke
Section snippets
Background
Peripheral arterial disease (PAD) is associated with increased risk of stroke and myocardial infarction (MI) [1], [2], [3], [4]. Ankle-brachial index (ABI) is a marker of PAD and the degree of ABI lowering correlates well with PAD severity [5], [6]. In published studies, PAD assessed by dichotomized ABI is associated with carotid disease [7], intracranial large arterial disease [4] and subsequent vascular events [2], [3], [4] following stroke. However, no study has yet reported on the relation
Methods
We recruited consecutive acute ischemic stroke patients admitted to the Singapore General Hospital from 2003 to 2004. Patients with hemorrhagic stroke were excluded. This study was approved by the Singapore General Hospital Institutional Review Board. Patients or their next-of-kin gave written informed consent as per Singapore Good Clinical Practice Guidelines.
Ischemic stroke was diagnosed by a neurologist based on clinical presentation and brain imaging, either brain computed tomography or
Results
During the study period, 1311 (93%) of the 1414 patients admitted for acute ischemic stroke participated in the study, among which 1299 (99%) had follow-up data at 1 year and were included in these analyses. Table 1 shows the baseline characteristics of the participants. Median ABI was 1.00 (IQR 0.89–1.08); 73% had ABI 0.9–1.3 (normal), 13% had ABI 0.8–0.89 (mildly lowered), 13% had ABI < 0.8 (severely lowered) and 1% had ABI > 1.3 (high). A history of limb claudication symptoms was present in
Discussion
In this study of Asian ischemic stroke patients, severe ABI lowering (<0.8) was associated with severe ECD and ICLAD as well as subsequent vascular events, whereas a milder degree of ABI lowering (0.8–0.89) was not. These findings are in line with the German get ABI study of healthy elderly patients which showed that lower ABI categories were associated with higher stroke rates [6]. Thus, it is important to consider the degree of ABI lowering in the relationship between PAD and cerebral
Conclusion
Among ischemic stroke patients, severe extracranial carotid disease, intracranial large arterial disease and incidence of subsequent vascular events were associated with severe ABI lowering (<0.8), but not with mild ABI lowering (0.8–0.89).
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Abnormal ankle-brachial index (ABI) predicts primary and secondary cardiovascular risk and cancer mortality
2020, European Journal of Internal MedicinePeripheral arterial disease and atrial fibrillation and risk of stroke, heart failure hospitalization and cardiovascular death: A nationwide cohort study
2016, International Journal of CardiologyPredictive value of ankle-brachial index and PAI-1 in symptomatic intracranial atherosclerotic disease recurrence
2014, AtherosclerosisCitation Excerpt :Additionally, there is limited evidence suggesting ABI as short-term prognostic factor [9]. Regarding the above-mentioned, it is important to emphasize the fact that ABI is unlikely to improve prediction of strokes due to cardioembolism or small vessel disease, and so it is only expected to predict recurrence of ICAD strokes [10]. Moreover, this prognostic ability is apparently stronger at lower ABI values [9,10,21].
Intracranial atherosclerosis
2014, The Lancet