Herraiz-Adillo Ángel, Mariana-Herraiz Julián Á, Pozuelo-Carrascosa Diana P
Department of Primary Care, Health Service of Castilla-La Mancha (SESCAM), Tragacete, Cuenca, Spain.
University of Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain.
Int Angiol. 2019 Jun;38(3):256-263. doi: 10.23736/S0392-9590.19.04167-1. Epub 2019 May 30.
Doppler Ankle Brachial Index (ABI), the non-invasive reference standard for peripheral arterial disease (PAD) in Primary Care, has proved good capacity to predict all-cause mortality. However, the role of oscillometric ABI is uncertain. This study aims to evaluate the ability of oscillometric and Doppler ABI to predict all-cause mortality in a Primary Care population.
Oscillometric and Doppler ABI were measured in 203 consecutive subjects with ≥1 cardiovascular risk factors or intermittent claudication. Pathologic ABI was defined when ABI was ≤0.9 or ≥1.4, and when the oscillometer was unable to record a value (oscillometric error). All-cause mortality was ascertained through examination of electronic medical records or telephone contact.
After analyzing 602.9 subjects/year, all-cause mortality was recorded in 17 (8.4%) patients. Kaplan-Meier survival curves for oscillometric (Log-Rank test χ2=66.02, P<0.001) and Doppler ABI (Log-Rank test χ2=42.30, P<0.001) showed that a pathologic ABI is associated with all-cause mortality. After adjusting for covariates, the hazard ratio in multivariable Cox regression were 4.52 (95% CI: 1.67-12.18, P=0.003) and 2.08 (95% CI: 0.83-5.18, P=0.117) for oscillometric and Doppler ABI models, respectively. When introducing oscillometric and Doppler ABI simultaneously in the Cox regression model, only oscillometric ABI was an independent predictor with a hazard ratio=7.90 (95% CI: 1.79-34.83, P=0.006). Regarding Doppler ABI, no significant differences were found in all-cause mortality between low ABI (≤0.9) and calcified ABI (≥1.4), (Log-Rank test χ2=0.98, P=0.322).
Oscillometric ABI predicted all-cause mortality in a Primary Care population even better than Doppler ABI, irrespective of cardiovascular risk factors. Oscillometric ABI, due to a high feasibility, could routinely identify high-risk patients to implement preventive measures.
多普勒踝臂指数（ABI）是基层医疗中用于外周动脉疾病（PAD）的无创参考标准，已被证明具有良好的预测全因死亡率的能力。然而，示波法ABI的作用尚不确定。本研究旨在评估示波法和多普勒ABI预测基层医疗人群全因死亡率的能力。
对203例具有≥1种心血管危险因素或间歇性跛行的连续受试者测量示波法和多普勒ABI。当ABI≤0.9或≥1.4，以及示波仪无法记录值（示波测量误差）时，定义为病理性ABI。通过查阅电子病历或电话联系确定全因死亡率。
在分析了602.9受试者/年之后，17例（8.4%）患者记录了全因死亡率。示波法（对数秩检验χ2=66.02，P<0.001）和多普勒ABI（对数秩检验χ2=42.30，P<0.001）的Kaplan-Meier生存曲线显示，病理性ABI与全因死亡率相关。在对协变量进行调整后，示波法和多普勒ABI模型在多变量Cox回归中的风险比分别为4.52（95%CI：1.67-12.18，P=0.003）和2.08（95%CI：0.83-5.18，P=0.117）。当在Cox回归模型中同时引入示波法和多普勒ABI时，只有示波法ABI是独立预测因子，风险比=7.90（95%CI：1.79-34.83，P=0.006）。关于多普勒ABI，低ABI（≤0.9）和钙化ABI（≥1.4）之间在全因死亡率方面未发现显著差异（对数秩检验χ2=0.98，P=0.322）。
示波法ABI预测基层医疗人群全因死亡率的能力甚至优于多普勒ABI，无论心血管危险因素如何。由于高度的可行性，示波法ABI可常规识别高危患者以实施预防措施。
