Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA.
Department of Cardiovascular Diseases at the Mayo Clinic, Rochester, MN, USA.
J Osteopath Med. 2021 Mar 11;121(5):463-470. doi: 10.1515/jom-2020-0290.
Peripheral artery disease (PAD) is highly prevalent in the general population, affecting up to 25% of patients 55 years of age or older. There is a known association with acute ischemic stroke, but limited large cohort studies exist pertaining to the relationship between PAD severity and incident ischemic stroke.
To evaluate the risk of incident ischemic stroke and mortality along the spectrum of low and elevated ankle brachial index (ABI) measurement.
We performed a retrospective extraction of ABI data of all adult patients who underwent lower extremity physiology study for any indication from January 1, 1996 to June 30, 2018 in the Mayo Clinic health system. PAD was categorized into severe, moderate, mild, and borderline based on ABI measurements and poorly compressible arteries (PCA). These were compared with normal ABI measurements. Associations of PAD/PCA with new ischemic stroke events and all cause mortality were analyzed. Hazard ratios (HR) were calculated using multivariable Cox proportional regression with 95% confidence intervals.
A total of 39,834 unique patients were included with a median follow up duration of 4.59 years. All abnormal ABI groups, except borderline PAD, were associated with increased risk of incident ischemic stroke after multivariate regression compared to normal ABI. A severity-dependent association was observed between PAD and ischemic stroke with moderate (HR, 1.22 [95% CI, 1.10-1.35]) and severe (HR, 1.19 [95% CI, 1.02-1.40]) categories conferring similar risk in comparison to normal ABI. Patients with PCA carried the greatest ischemic stroke risk (HR, 1.30 [95% CI, 1.15-1.46]). Similarly, abnormal ABI groups were associated with a significant risk for all cause mortality in a severity-dependent manner, with severe PAD conferring the greatest risk (HR, 3.07 [95% CI, 2.88-3.27]).
This study adds to the growing body of evidence that both PAD and PCA are independent risk factors for incident ischemic stroke and all cause mortality. The association of PAD severity and PCA with risk of ischemic stroke may help clinicians with risk stratification and determining treatment intensity.
外周动脉疾病（PAD）在普通人群中发病率很高，55 岁或以上的患者中高达 25%。已知其与急性缺血性脑卒中有关，但与 PAD 严重程度和缺血性脑卒中事件之间的关系相关的大样本队列研究有限。
评估在低和高踝臂指数（ABI）测量范围内，发生缺血性脑卒中及死亡的风险。
我们对 1996 年 1 月 1 日至 2018 年 6 月 30 日期间，在梅奥诊所健康系统因任何原因接受下肢生理学研究的所有成年患者的 ABI 数据进行了回顾性提取。根据 ABI 测量值和不可压缩动脉（PCA）将 PAD 分为严重、中度、轻度和边界。将其与正常 ABI 测量值进行比较。分析 PAD/PCA 与新发缺血性脑卒中事件和全因死亡率的相关性。使用多变量 Cox 比例回归计算风险比（HR），置信区间为 95%。
共纳入 39834 例患者，中位随访时间为 4.59 年。与正常 ABI 相比，除边界 PAD 外，所有异常 ABI 组在多变量回归后发生缺血性脑卒中的风险均增加。PAD 与缺血性脑卒中之间存在一种严重程度相关的关联，中度（HR，1.22 [95%CI，1.10-1.35]）和重度（HR，1.19 [95%CI，1.02-1.40]）组与正常 ABI 相比，风险相似。存在 PCA 的患者发生缺血性脑卒中的风险最大（HR，1.30 [95%CI，1.15-1.46]）。同样，异常 ABI 组与全因死亡率呈显著的严重程度相关，重度 PAD 风险最大（HR，3.07 [95%CI，2.88-3.27]）。
本研究进一步证实，PAD 和 PCA 均是缺血性脑卒中及全因死亡率的独立危险因素。PAD 严重程度和 PCA 与缺血性脑卒中风险的相关性可能有助于临床医生进行风险分层和确定治疗强度。
