Han Minho, Kim Young Dae, Lee Ilhyung, Lee Hyungwoo, Heo Joonnyung, Lee Hye Sun, Nam Hyo Suk
Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, South Korea.
Front Neurol. 2021 Dec 20;12:754258. doi: 10.3389/fneur.2021.754258. eCollection 2021.
We investigated whether the toe-brachial index (TBI) is associated with stroke prognosis and evaluated this association in patients with normal ankle-brachial index (ABI). Acute ischemic stroke patients who underwent TBI measurements were enrolled. Poor functional outcome was defined as modified Rankin Scale score ≥3. Major adverse cardiovascular event (MACE) was defined as stroke recurrence, myocardial infarction, or death. Normal ABI was defined as 0.9 ≤ ABI ≤ 1.4. A total of 1,697 patients were enrolled and followed up for a median 39.7 (interquartile range, 25.7-54.6) months. During the period, 305 patients suffered MACE (18.0%), including 171 (10.1%) stroke recurrences. TBI was associated with hypertension, diabetes, atrial fibrillation, aortic plaque score, ABI, and brachial-ankle pulse wave velocity (all < 0.05). In multivariable logistic regression, TBI was inversely associated with poor functional outcome in all patients [odds ratio (OR) 0.294, 95% confidence interval (CI) 0.114-0.759], even in patients with normal ABI (OR 0.293, 95% CI 0.095-0.906). In multivariable Cox regression, TBI < 0.6 was associated with stroke recurrence [hazard ratio (HR) 1.651, 95% CI 1.135-2.400], all-cause mortality (HR 2.105, 95% CI 1.343-3.298), and MACE (HR 1.838, 95% CI 1.396-2.419) in all patients. TBI < 0.6 was also associated with stroke recurrence (HR 1.681, 95% CI 1.080-2.618), all-cause mortality (HR 2.075, 95% CI 1.180-3.651), and MACE (HR 1.619, 95% CI 1.149-2.281) in patients with normal ABI. Low TBI is independently associated with poor short- and long-term outcomes in acute ischemic stroke patients despite normal ABI.
我们研究了趾臂指数（TBI）是否与卒中预后相关，并在踝臂指数（ABI）正常的患者中评估了这种关联。纳入了接受TBI测量的急性缺血性卒中患者。功能预后不良定义为改良Rankin量表评分≥3。主要不良心血管事件（MACE）定义为卒中复发、心肌梗死或死亡。正常ABI定义为0.9≤ABI≤1.4。共纳入1697例患者，中位随访39.7（四分位间距，25.7 - 54.6）个月。在此期间，305例患者发生MACE（18.0%），包括171例（10.1%）卒中复发。TBI与高血压、糖尿病、心房颤动、主动脉斑块评分、ABI及臂踝脉搏波速度均相关（均P<0.05）。在多变量逻辑回归分析中，TBI与所有患者的功能预后不良呈负相关[比值比（OR）0.294，95%置信区间（CI）0.114 - 0.759]，即使在ABI正常的患者中也是如此（OR 0.293，95%CI 0.095 - 0.906）。在多变量Cox回归分析中，TBI<0.6与所有患者的卒中复发[风险比（HR）1.651，95%CI 1.135 - 2.400]、全因死亡率（HR 2.105，95%CI 1.343 - 3.298）及MACE（HR 1.838，95%CI 1.396 - 2.419）相关。TBI<0.6在ABI正常的患者中也与卒中复发（HR 1.681，95%CI 1.080 - 2.618）、全因死亡率（HR 2.075，95%CI 1.180 - 3.651）及MACE（HR 1.619，95%CI 1.149 - 2.281）相关。尽管ABI正常，但低TBI与急性缺血性卒中患者的短期和长期不良预后独立相关。
