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Ankle-brachial index and cardiovascular outcomes in the Bypass Angioplasty Revascularization Investigation 2 Diabetes trial.

BACKGROUND: Peripheral arterial disease increases cardiovascular risk in many patient populations. The risks associated with an abnormal ankle-brachial index (ABI) in patients with type 2 diabetes and stable coronary artery disease have not been well described with respect to thresholds and types of cardiovascular events. METHODS: We examined 2,368 patients in the BARI 2D trial who underwent ABI assessment at baseline. Death and major cardiovascular events (death, myocardial infarction and stroke) during follow-up (average 4.3 years) were assessed across the ABI spectrum and by categorized ABI: low (≤0.90), normal (0.91-1.3), high (>1.3), or noncompressible. RESULTS: A total of 12,568 person-years were available for mortality analysis. During follow-up, 316 patients died, and 549 had major cardiovascular events. After adjustment for potential confounders, with normal ABI as the referent group, a low ABI conferred an increased risk of death (relative risk [RR] 1.6, CI 1.2-2.2, P = .0005) and major cardiovascular events (RR 1.4, CI 1.1-1.7, P = .004). Patients with a high ABI had similar outcomes as patients with a normal ABI, but risk again increased in patients with a noncompressible ABI with a risk of death (RR 1.9, CI 1.3-2.8, P = .001) and major cardiovascular event (RR 1.5, CI 1.1-2.1, P = .01). CONCLUSIONS: In patients with coronary artery disease and type 2 diabetes, ABI screening and identification of ABI abnormalities including a low ABI (<1.0) or noncompressible artery provide incremental prognostic information.

Pubmed ID: 23067918


  • Abbott JD
  • Lombardero MS
  • Barsness GW
  • Pena-Sing I
  • Buitrón LV
  • Singh P
  • Woodhead G
  • Tardif JC
  • Kelsey SF


American heart journal

Publication Data

October 16, 2012

Associated Grants

  • Agency: NHLBI NIH HHS, Id: U01 HL061744

Mesh Terms

  • Ankle Brachial Index
  • Cause of Death
  • Coronary Artery Disease
  • Diabetes Mellitus, Type 2
  • Diabetic Angiopathies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction
  • Peripheral Vascular Diseases
  • Prognosis
  • Risk
  • Stroke
  • Survival Rate