Key result
An initial ankle-brachial pressure index (ABPI) <0.50 was associated with a 60% cardiovascular morbidity rate compared with 12% for an ABPI >0.70 (p<0.005).
Cohort (n=110)
Absolute Event Rate: 60% vs 12%
p-value: p=<0.005
In patients with intermittent claudication, a lower initial ankle-brachial pressure index (ABPI) strongly predicts a higher risk of subsequent cardiovascular events, despite a relatively benign prognosis for the limb itself.
Low ABPI may flag higher CV risk in claudication but should not yet alter practice; leaves open need for prospective validation.
To determine the natural history of intermittent claudication, 110 patients were followed up for a mean period of 24.4 +/- 1.2 months. Four patients died during the follow-up. Of the survivors, 24 experienced a nonfatal cardiovascular event, myocardial infarction being the most frequent. Cumulative cardiovascular morbidity was 29% at 3 years. Cox proportional-hazards analysis showed initial ankle-brachial pressure index (ABPI) as a significant predictor for nonfatal cardiovascular events (p<0.002). With an initial ABPI >0.70, cardiovascular morbidity rate was 12% compared with 33% for those with initial ABPI ranging from 0.70 to 0.50, and 60% for those with ABPI <0.50 (p<0.005). Critical limb ischemia occurred in only four patients, amputation was required in two, and arterial reconstruction in five. Of the 85 patients who participated in the treadmill test, maximum walking capacity worsened in 26% and improved in 27%. This study elucidates the neglected area of cardiovascular morbidity in intermittent claudication. It has shown that ABPI identifies a subgroup of patients for whom the risk of cardiovascular events is especially pronounced. On the other hand, based on objective evaluation of the patient status, the relatively benign prognosis for the claudicant limb has been confirmed.
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Martone et al. (1998) conducted a cohort in Intermittent claudication (n=110). Initial ankle-brachial pressure index (ABPI) <0.50 vs. ABPI >0.70 was evaluated on nonfatal cardiovascular events (p=<0.005). An initial ankle-brachial pressure index (ABPI) <0.50 was associated with a 60% cardiovascular morbidity rate compared with 12% for an ABPI >0.70 (p<0.005).
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