From the Hotel Dieu de France, Saint Joseph University, Beirut, Lebanon (H.A.).
Department of Neurology and Stroke Center (H.A., J.L., L.M.T., P.A.), Bichat University Hospital, Paris, France.
Stroke. 2019 Apr;50(4):853-858. doi: 10.1161/STROKEAHA.118.022180.
Background and Purpose- Low ankle-brachial index (ABI) identifies a stroke subgroup with high risk of recurrent stroke, cardiovascular events, and death. However, limited data exist on the relationship between low ABI and stroke in low and middle-income countries. Therefore, we evaluated the prevalence of ABI ≤0.90 (which is diagnostic of peripheral artery disease) in nonembolic stroke patients or transient ischemic attack and assessed the correlation of low ABI with stroke risk, factors, and recurrent vascular events and death. Methods- Patients ≥45 years with acute transient ischemic attack or minor ischemic strokes were recruited consecutively from over 17 low-income and middle-income countries (Latin America [1543 patients], Middle East [1041 patients], North Africa [834 patients], and South Africa [217 patients]). The ABI measurement was performed at a single visit. Stroke recurrence and risk of new vascular events were assessed after 24 months of follow-up. Results- Among 3487 enrolled patients, abnormal ABI (<0.9) was present in 22.3 %. Patients with an ABI of ≤0.9 were more likely ( P<0.05) to be male, older, and have a history of peripheral artery disease, hypertension, and diabetes mellitus. During 2-year follow-up, the rate of major cardiovascular event was higher in patients with ABI <0.9 than those with ABI ≥0.9 (Kaplan-Meier estimates, 22.5%; 95% CI, 19.6-25.8 versus 13.7%; 21.4-15.1; P<0.001), and when ABI was categorized into 4 groups (≤0.6; 95% CI, 0.6-0.9; 0.9-1; 1-1.4), the rate of major cardiovascular event was higher in those with ABI ≤0.6 than the other groups (Kaplan-Meier estimates, 32.6%; 95% CI, 21.0-48.3 for ABI≤0.6 versus 21.7%; 95% CI, 18.8-25.0 for ABI 0.6-0.9 versus 14.3%; 95% CI, 12.4-16.6 for ABI 0.9-1 versus 13.3%; 95% CI, 11.6-15.2 for ABI 1-1.4; P<0.001). Conclusions- Among patients with nonembolic ischemic stroke or transient ischemic attack, those with low ABI had a higher rate of vascular events and death in this population. Screening for ABI in stroke patients may help identify patients at high risk of future events.
背景与目的- 低踝臂指数（ABI）可识别出具有高复发性卒中、心血管事件和死亡风险的卒中亚组。然而，在中低收入国家，关于低 ABI 与卒中之间关系的相关数据有限。因此，我们评估了非栓塞性卒中患者或短暂性脑缺血发作患者中 ABI≤0.90（诊断为外周动脉疾病）的发生率，并评估了低 ABI 与卒中风险、因素以及复发性血管事件和死亡之间的相关性。方法- 连续纳入来自 17 个中低收入国家（拉丁美洲[1543 例]、中东[1041 例]、北非[834 例]和南非[217 例]）的年龄≥45 岁的急性短暂性脑缺血发作或小卒中患者。在单次就诊时进行 ABI 测量。在 24 个月的随访后评估卒中复发和新血管事件的风险。结果- 在 3487 名入组患者中，22.3%存在异常 ABI（<0.9）。ABI≤0.9 的患者更可能为男性、年龄更大，且有外周动脉疾病、高血压和糖尿病病史。在 2 年随访期间，ABI＜0.9 的患者主要心血管事件发生率高于 ABI≥0.9 的患者（Kaplan-Meier 估计值，22.5%；95%CI，19.6-25.8 与 13.7%；95%CI，15.1-13.7；P＜0.001），当 ABI 分为 4 组（≤0.6；95%CI，0.6-0.9；0.9-1；1-1.4）时，ABI≤0.6 的患者主要心血管事件发生率高于其他组（Kaplan-Meier 估计值，32.6%；95%CI，21.0-48.3 与 ABI≤0.6 相比，ABI 0.6-0.9 的估计值为 21.7%；95%CI，18.8-25.0，ABI 0.9-1 的估计值为 14.3%；95%CI，12.4-16.6，ABI 1-1.4 的估计值为 13.3%；95%CI，11.6-15.2；P＜0.001）。结论- 在非栓塞性缺血性卒中和短暂性脑缺血发作患者中，ABI 较低的患者在该人群中发生血管事件和死亡的风险更高。对卒中患者进行 ABI 筛查可能有助于识别未来发生事件风险较高的患者。
