Feringa Harm H H, Bax Jeroen J J, van Waning Virginie H, Boersma Eric, Elhendy Abdou, Schouten Olaf, Tangelder Marco J, van Sambeek Marc H R M, van den Meiracker Anton H, Poldermans Don
Department of Anesthesiology, Erasmus Medical Centre, Rotterdam, Netherlands.
Arch Intern Med. 2006 Mar 13;166(5):529-35. doi: 10.1001/archinte.166.5.529.
Peripheral arterial disease is associated with a high incidence of cardiovascular mortality. Peripheral arterial disease can be detected by using the ankle-brachial index (ABI). This study assessed the prognostic value of the postexercise ABI in addition to the resting ABI on long-term mortality in patients with suspected peripheral arterial disease.
In this prospective cohort study of 3209 patients (mean +/- SD age, 63 +/- 12 years; 71.1% male), resting and postexercise ABI values were measured and a reduction of postexercise ABI over baseline resting readings was calculated. The mean follow-up was 8 years (interquartile range, 4-11 years).
During follow-up, 1321 patients (41.2%) died. After adjusting for clinical risk factors, lower resting ABI values (hazard ratio per 0.10 lower ABI, 1.08; 95% confidence interval [CI], 1.06-1.10), lower postexercise ABI values (hazard ratio per 0.10 lower ABI, 1.09; 95% CI, 1.08-1.11), and higher reductions of ABI values over baseline readings (hazard ratio per 10% lower ABI, 1.12; 95% CI, 1.09-1.14) were significantly associated with a higher incidence of mortality. In patients with a normal resting ABI (n = 789), a reduction of the postexercise ABI by 6% to 24%, 25% to 55%, and greater than 55% was associated with a 1.6-fold (95% CI, 1.2-2.2), 3.5-fold (95% CI, 2.4-5.0), and 4.8-fold (95% CI, 2.5-9.1) increased risk of mortality, respectively.
Resting and postexercise ABI values are strong and independent predictors of mortality. A reduction of postexercise ABI over baseline readings can identify additional patients (who have normal ABI values at rest) at increased risk of subsequent mortality.
外周动脉疾病与心血管疾病高死亡率相关。外周动脉疾病可通过踝臂指数（ABI）检测。本研究评估了运动后ABI除静息ABI外对疑似外周动脉疾病患者长期死亡率的预后价值。
在这项对3209例患者（平均年龄±标准差为63±12岁；71.1%为男性）的前瞻性队列研究中，测量了静息和运动后ABI值，并计算了运动后ABI相对于基线静息读数的降低值。平均随访时间为8年（四分位间距为4 - 11年）。
随访期间，1321例患者（41.2%）死亡。在调整临床危险因素后，较低的静息ABI值（每降低0.10的ABI危险比为1.08；95%置信区间[CI]为1.06 - 1.10）、较低的运动后ABI值（每降低0.10的ABI危险比为1.09；95%CI为1.08 - 1.11）以及相对于基线读数更高的ABI值降低幅度（每降低10%的ABI危险比为1.12；95%CI为1.09 - 1.14）均与较高的死亡率显著相关。在静息ABI正常的患者（n = 789）中，运动后ABI降低6%至24%、25%至55%以及大于55%分别与死亡率增加1.6倍（95%CI为1.2 - 2.2）、3.5倍（95%CI为2.4 - 5.0）和4.8倍（95%CI为2.5 - 9.1）相关。
静息和运动后ABI值是死亡率的强有力且独立的预测指标。运动后ABI相对于基线读数的降低可识别出随后死亡风险增加的额外患者（静息时ABI值正常）。
