Department of Internal Medicine/Vascular Medicine, SRH-Klinikum Karlsbad-Langensteinbach, Affiliated Teaching Hospital, University of Heidelberg, Guttmannstr 1, D-76307 Karlsbad, Germany.
Atherosclerosis. 2011 Feb;214(2):364-72. doi: 10.1016/j.atherosclerosis.2010.11.030. Epub 2010 Nov 27.
We aimed to investigate whether the post-exercise ankle brachial index (ABI) performed by primary care physicians offers useful information for the prediction of death or cardiovascular events, beyond the traditional resting ABI. An additional focus was on patients with intermittent claudication and normal resting ABI.
Using data from the 5-year follow-up of 6468 elderly patients in the primary care setting in Germany (getABI study) we used multivariate Cox regression models adjusted for age, gender and conventional risk factors to determine the association of resting ABI and/or post-exercise ABI and all-cause mortality/morbidity.
Mean post-exercise ABI in the total cohort was 0.977 and resting ABI was 1.034. For post-exercise ABI, a threshold value of 0.825 had nearly the same sensitivity (28.6%) and specificity (85.7%) as the conventionally used resting ABI with a cut-off value of 0.9 to predict death. Compared to patients with normal post-exercise ABI, a low post-exercise ABI was associated with an almost identical risk increase for mortality (hazard ratio [HR] 1.56, 95% confidence interval [CI] 1.30-1.86) as a low resting ABI (HR 1.65; CI 1.39-1.97) and/or myocardial infarction/stroke. Slight differences were observed for coronary/carotid revascularisation and peripheral revascularisation/amputation. In combined models it could not be shown that post-exercise ABI yielded relevant additional information for the prognosis of mortality and/or myocardial infarction/stroke, not even in the subgroup analysis of patients with intermittent claudication and normal resting ABI.
It could not be shown that the post-exercise ABI is a useful tool for the prognosis of mortality and/or myocardial infarction/stroke beyond the resting ABI.
我们旨在研究初级保健医生进行的运动后踝臂指数（ABI）是否除了传统的静息 ABI 外，还能为预测死亡或心血管事件提供有用信息。另外，我们还关注间歇性跛行且静息 ABI 正常的患者。
利用来自德国初级保健环境中 6468 例老年患者 5 年随访数据（getABI 研究），我们使用多变量 Cox 回归模型，调整年龄、性别和传统危险因素，以确定静息 ABI 和/或运动后 ABI 与全因死亡率/发病率的相关性。
总队列的平均运动后 ABI 为 0.977，静息 ABI 为 1.034。对于运动后 ABI，阈值为 0.825 时，预测死亡的灵敏度（28.6%）和特异性（85.7%）几乎与传统的使用静息 ABI 截断值为 0.9 时相同。与运动后 ABI 正常的患者相比，运动后 ABI 降低与死亡率的风险增加几乎相同（危险比 [HR] 1.56，95%置信区间 [CI] 1.30-1.86），与静息 ABI 降低（HR 1.65；CI 1.39-1.97）和/或心肌梗死/中风相同。对于冠状动脉/颈动脉血运重建和外周血运重建/截肢，观察到细微差异。在联合模型中，不能证明运动后 ABI 对死亡率和/或心肌梗死/中风的预后有任何额外的信息，即使在间歇性跛行且静息 ABI 正常的亚组分析中也是如此。
不能证明运动后 ABI 是预测死亡率和/或心肌梗死/中风除静息 ABI 之外的有用工具。
