Hajibandeh Shahab, Hajibandeh Shahin, Shah Sohan, Child Emma, Antoniou George A, Torella Francesco
1 Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital & University Hospital Aintree, Liverpool, UK.
2 Library Resource & Information Centre, University Hospital Aintree, Liverpool, UK.
Vascular. 2017 Apr;25(2):208-224. doi: 10.1177/1708538116658392. Epub 2016 Jul 19.
Purpose To synthesize and quantify the excess risk of morbidity and mortality in individuals with low ankle-brachial pressure index. Methods Electronic databases were searched to identify studies investigating morbidity and mortality outcomes in individuals undergoing ankle-brachial pressure index measurement. Meta-analysis of the outcomes was performed using fixed- or random-effects models. Uncertainties related to varying follow-up periods among the studies were resolved by meta-analysis of time-to-event outcomes. Results Forty-three observational cohort studies, enrolling 94,254 participants, were selected. A low ankle-brachial pressure index (<0.9) was associated with a significant risk of all-cause mortality (risk ratio: 2.52, 95% CI 2.26-2.82, P < 0.00001); cardiovascular mortality (risk ratio: 2.94, 95% CI 2.72-3.18, P < 0.00001); cerebrovascular event (risk ratio: 2.17, 95% CI 1.90-2.47, P < 0.00001); myocardial infarction (risk ratio: 2.28, 95% CI 2.07-2.51, P < 0.00001); fatal myocardial infarction (risk ratio: 2.81, 95% CI 2.33-3.40, P < 0.00001); fatal stroke (risk ratio: 2.28, 95% CI 1.80-2.89, P < 0.00001); and the composite of myocardial infarction, stroke, and death (risk ratio: 2.29, 95% CI 1.87-2.81, P < 0.00001). Similar findings resulted from analyses of individuals with asymptomatic PAD, individuals with cardiovascular or cerebrovascular co-morbidity, and patients with diabetes. Conclusions A low ankle-brachial pressure index is associated with an increased risk of subsequent cardiovascular and cerebrovascular morbidity and mortality. Randomised controlled trials are required to investigate the effectiveness of screening for PAD in asymptomatic and undiagnosed individuals and to evaluate benefits of early treatment of screen-detected PAD.
目的 综合并量化踝臂压力指数较低个体的发病和死亡额外风险。方法 检索电子数据库，以识别调查接受踝臂压力指数测量个体的发病和死亡结局的研究。使用固定效应或随机效应模型对结局进行荟萃分析。通过对事件发生时间结局的荟萃分析解决研究中不同随访期相关的不确定性。结果 选取了43项观察性队列研究，纳入94,254名参与者。低踝臂压力指数（<0.9）与全因死亡率（风险比：2.52，95%可信区间2.26 - 2.82，P < 0.00001）、心血管死亡率（风险比：2.94，95%可信区间2.72 - 3.18，P < 0.00001）、脑血管事件（风险比：2.17，95%可信区间1.90 - 2.47，P < 0.00001）、心肌梗死（风险比：2.28，95%可信区间2.07 - 2.51，P < 0.00001）、致命性心肌梗死（风险比：2.81，95%可信区间2.33 - 3.40，P < 0.00001）、致命性卒中（风险比：2.28，95%可信区间1.80 - 2.89，P < 0.00001）以及心肌梗死、卒中和死亡的复合结局（风险比：2.29，95%可信区间1.87 - 2.81，P < 0.00001）的显著风险相关。对无症状外周动脉疾病个体、有心血管或脑血管合并症个体以及糖尿病患者的分析得出了类似结果。结论 低踝臂压力指数与随后心血管和脑血管发病及死亡风险增加相关。需要进行随机对照试验，以研究对无症状和未诊断个体筛查外周动脉疾病的有效性，并评估对筛查发现的外周动脉疾病进行早期治疗的益处。
