Low ankle-brachial index tied to worse outcomes in CAD patients with DES

In patients with coronary artery disease (CAD) treated with drug-eluting stents (DESs), a low ankle-brachial index (ABI) is predictive of poor long-term outcomes, a recent study has found.

Researchers retrospectively assessed 181 CAD patients who had received DESs. ABI was measured prior to percutaneous coronary intervention (PCI) using a Doppler device, and a threshold of 0.9 was used as the basis of stratifying the participants into two: low-ABI group (ABI <0.9; n=29) and the true normal ABI group (0.9≤ABI<1.4; n=152).

Patients in the low-ABI group were older and more commonly had diabetes, chronic kidney disease and a history of PCI than their counterparts in the true normal group. The respective median follow-up durations were 45 and 42 months. Multivessel disease was likewise more prevalent in those with low ABI.

Fifteen deaths were reported over the follow-up period. The primary outcome of target lesion revascularization (TLR) occurred significantly more frequently in patients with low vs normal ABI values (41.4 percent vs 9.9 percent; p<0.001).

The same was true for all-cause mortality (31.0 percent vs 3.9 percent; p<0.001) and major adverse cardiac and cerebrovascular events (MACCE; 48.3 percent vs 11.2 percent; p<0.001).

Multivariable Cox proportion hazards analysis confirmed these. Patients with low ABI were significantly more likely to need TLR (hazard ratio [HR], 5.28, 95 percent confidence interval [CI], 1.61–17.33; p=0.006) and MACCEs (HR, 5.04, 95 percent CI, 1.82–13.98; p=0.002). The significance of mortality was attenuated after multivariable adjustment (p=0.07).