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ISSN 2221-2434 (Electronic)

2020, Number 3

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Finlay 2020; 10 (3)

The ankle-brachial index as a predictor of multivess el coronary disease in patients with acute coronary syndrome and peripheral arterial disease

Negrín VT, Rodríguez JAE, Fardales RR, Castellanos GLA, Meneses JJC, López CMAlina

Language: Spanish
References: 30
Page: 209-221
PDF size: 579.48 Kb.


ABSTRACT

Background: the coexistence of peripheral arterial disease and acute coronary syndrome is associated with a worse prognosis. The ankle-brachial index has been shown to be a marker of multisite atherosclerosis.
Objective: to determine the relationship between the ankle-brachial index and coronary artery disease.
Method: an analytical observational study was carried out that included all the patients discharged from the coronary care unit of the Camilo Cienfuegos Gorriarán Provincial University Hospital, of the Sancti Spíritus province, in the period from March 1, 2011 to February 30 of 2018, with a diagnosis of acute coronary syndrome, with and without ST segment elevation. Clinical data, ankle-brachial index, echocardiography and coronary angiography were collected and the prognostic implication of the index in disease was determined through a classification tree with the variables included in the binary logistic regression model.
Results: multivessel disease occurred in 85.2 % patients, 81.9 % of them were men, 85.9 % of them with multivessel disease, the mean age was 59.1 years, 52.3 % presented STEACS with multivessel disease 78.8 %. The most frequent risk factors were: smoking (86.8 %), dyslipidemia (85.8 %) and arterial hypertension (84.8 %) in the group with multivessel disease and ABI = 0.9 (SD = 0.3). They received treatment with clopidogrel (86.1 %), acetylsalicylic acid (86.3 %), ACEI or ARB (85.8 %), statins (73.2 %), beta-blockers (87.5 %) and nitrates (86, 3 %). On angiography, 85.2 % had severe coronary disease. The two-predictor variables were: NSTEACS and ABI≤0.9, which showed a high positive predictive value in the prognosis of multivessel coronary artery disease.
Conclusions: ankle-brachial index <0.9 showed a predictive capacity for multivessel disease that increases if it is associated with diabetes mellitus and smoking.


REFERENCES

  1. Dieter R, Chu WW, Pacanowski JP, McBride PE, Tanke TE. The significance of lower extremity peripheral arterial disease. Clin Cardiol. 2002;25(1):3-10.

  2. Fowkes FG, Rudan D, Rudan I, Aboyans V, Denenberg JO, Mc Dermott MM, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013;(382):1329-40.

  3. Wang H, Naghavi M, Allen C, Barber RM, Carter A, Casey DC, et al. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1459-1544.

  4. Valdés ER, Espinosa Y. Factores de riesgo asociados con la aparición de enfermedad arterial periférica en personas con diabetes mellitus tipo 2. Rev Cubana Med[Internet]. 2013[citado 9 Feb 2016];52(1):[aprox. 10p.]. Disponible en:http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034-75232013000100002.

  5. 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. Circulation. 2006;113(11):e1-e192.

  6. Ramos R, Baena JM, Quesada M, Solanas P, Subirana I, Sala J, et al. Derivation and validation of REASON: a risk score identifying candidates to screen for peripheral arterial disease using ankle brachial index. Atherosclerosis. 2011;214(2):474-9.

  7. Pande RL, Perlstein TS, Beckman JA, Creager MA. Secondary prevention and mortality in peripheral artery disease: National Health and Nutrition Examination Study, 1999 to 2004. Circulation. 2011;124(1):17-23.

  8. Sigvant B, Wiberg K, Bergqvist D, Rolandsson O, Andersson B, Persson E, et al. A population-based study of peripheral arterial disease prevalence with special focus on critical limb ischemia and sex differences. J Vasc Surg. 2007;45(6):1185-91.

  9. Tendera M, Aboyans V, Bartelink ML, Baumgartner I, Clement D, Collet JP, et al. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2011;32(22):2851-906.

  10. Sibley RC, Reis S, MacFarlane JJ, Reddick MA, Kalva SP, Sutphin PD. Noninvasive physiologic vascular studies: A guide to diagnosing peripheral arterial disease. RadioGraphics. 2016;37(1):160044.

  11. Tendera M, Aboyans V, Bartelink ML, Baumgartner I, Clément D, Collet JP, et al. Guía de práctica clínica de la ESC sobre diagnóstico y tratamiento de las enfermedades arteriales periféricas. Rev Esp Cardiol[Internet]. 2012[citado 10 May 2019];65(2):[aprox. 20p.]. Disponible en: https://www.revespcardiol.org/contenidos/static/avance_guias/Guia2012_2.pdf.

  12. Adeva MM, Funcasta R, Fernández C, Ameneiros E, Domínguez A. Subclinical vascular disease in patients with diabetes is associated with insulin resistance. Diabetes metabolic syndrome. 2019;13(3):2198-206.

  13. Poredos P, Jug B. The prevalence of peripheral arterial disease in high-risk subjects and coronary or cerebrovascular patients. Angiology. 2007;58(3):309-15.

  14. Falk E, Bentzo JF. New and Emerging Insights into the Pathobiology of Acute Myocardial Infarction. En: Zipes D, Libby P, Bonow R, Mann D, Tomaselli G, Braunwald E. Braunwald´s Heart Disease. A textbook of cardiovascular medicine. 11th. Philadelphia: Elsevier;2019. p. 22-33.

  15. López F, Cortés M. Obesidad y corazón. Rev Esp Cardiol[Internet]. 2011[citado 17 Nov 2019];64(2):[aprox. 9p.]. Disponible en: https://medes.com/publication/63845.

  16. Mitchell C, Rahko PS, Blauwet LA, Canaday B, Finstuen JA, Foster MC, et al. Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiograph. 2018;32(1):1-64.

  17. Cordero A, Morillas P, Bertomeu V, Quiles J, Soria F, Guindo J, et al. Pathological ankle-brachial index is equivalent of advanced age in acute coronary syndromes. Eur J of Clin Invest. 2011;41(12):1268-74.

  18. World Medical Association. Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191-4.

  19. Moussa ID, Jaff MR, Mehran R, Gray W, Dangas G, Lazic Z, et al. Prevalence and prediction of previously unrecognized peripheral arterial disease in patients with coronary artery disease: the Peripheral Arterial Disease in Interventional Patients Study. Catheter Cardiovasc Interv. 2009;73(6):719-24.

  20. Tendera M, Aboyans V, Bartelink ML, Baumgartner I, Clément D, Collet JP, et al. Guía de práctica clínica de la ESC sobre diagnóstico y tratamiento de las enfermedades arteriales periféricas. Rev Esp Cardiol[Internet]. 2012[citado 28 Oct 2019];65(2):[aprox. 12p.]. Disponible en: https://www.revespcardiol.org/es-guia-practica-clinica-esc-sobre-articulo-S030089321100933X.

  21. Lafitte M, Pucheu Y, Latry K, Dijos M, Casassus E, Couffinhal T. Predictors of cardiovascular prognosis in patients receiving optimized secondary prevention measures after acute coronary syndrome. Eur J Prev Cardiol. 2013;20(2):283-90.

  22. Korkmaz L, Adar A, Erkan H, Tarik M, Acar Z, Halil I, et al. Ankle-Brachial Index and Coronary Artery Lesion Complexity in Patients With Acute Coronary Syndromes. Angiology. 2012;63(7):495-9.

  23. Palmerini T, Genereux P, Caixeta A, Cristea E, Lansky A, George RM, et al. Prognostic value of the SYNTAX score in patients with acute coronary syndromes undergoing percutaneous coronary intervention: analysis from the acuity (Acute Catheterization and Urgent Intervention Triage Strategy trial. J Am Coll Cardiol. 2011;57(24):2389-97.

  24. Helmy H, Abdel A, Kishk YT, Sleem KM. Correlation of corrected QT dispersion with the severity of coronary artery disease detected by SYNTAX score in non-diabetic patients with STEMI. Egyptian Heart J. 2017;69(2):111-7.

  25. Cordero A, Morillas P, Bertomeu V, Quiles J, Soria F, Guindo J, et al. Pathological ankle-brachial index is equivalent of advanced age in acute coronary syndromes. Eur J Clin Invest. 2011;41(12):1268-74.

  26. Sasaki M, Mitsutake Y, Ueno T, Fukami A, Sasaki K, Yokoyama S, et al. Low ankle brachial index predicts poor outcomes including target lesion revascularization during the long-term follow up after drug-eluting stent implantation for coronary artery disease. J Cardiol. 2020;75(3):250-4.

  27. Bowlin SJ, Medalie JH, Flocke SA, Zyzanski SJ, Goldbourt U. Epidemiology of intermittent claudication in middle-aged men. Am J Epidemiol. 1994;140(5):418-30.

  28. Grenon M, Vittinghoff E, Owens CD, Conte MS, Whooley M, Cohen BE. Peripheral artery disease and risk of cardiovascular events in patients with coronary artery disease: Insights from the Heart and Soul Study. Vasc Med. 2013;18(4):176-184.

  29. Lin JS, Olson CM, Johnson ES, Senger CA, Whitlock EP. The Ankle-brachial Index for Peripheral Artery Disease Screening and Cardiovascular Disease Prediction among Asymptomatic Adults: A Systematic Evidence Review for the U.S. Preventive Services Task Force. Ann Inter Med. 2013;159(5):333-41.

  30. Feringa HH, Karagiannis SE, van Waning VH, Boersma E, Shouten O, Bax JJ, et al. The effect of intensified lipid-lowering therapy on long-term prognosis in patients with peripheral arterial disease. J Vasc Surg. 2007;45(5):936-43.




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