This article is more than 5 years old. Information may no longer be current.
High ankle-brachial index confers poor outcomes in CLI
Click Here to Manage Email Alerts
Patients with critical limb ischemia who had a high or immeasurable ankle-brachial index had poor amputation-free survival compared with patients with CLI and a low or intermediate ankle-brachial index, according to new data.
The researchers analyzed 260 patients with CLI from the PADI and JUVENTAS trials. In PADI, patients were randomly assigned to a drug-eluting stent or percutaneous transluminal angioplasty. In JUVENTAS, patients underwent repetitive intra-arterial infusion of bone marrow mononuclear cells.
Patients were stratified by ankle-brachial index: low, defined as less than 0.7; intermediate, defined as 0.7 to 1.4; and immeasurable or high, defined as more than 1.4. Outcomes of interest were major amputation and amputation-free survival at 5 years.
Those with high or immeasurable ankle-brachial index had higher rates of major amputation at 5 years (52.1%) vs. those with intermediate (25.5%) or low ankle-brachial index (23.5%; P < .001), Marlon I. Spreen, MD, PhD, from the department of radiology at Haga Teaching Hospital, The Hague, Netherlands, and colleagues wrote.
Amputation-free survival at 5 years was just 5% in the high or immeasurable ankle-brachial index group vs. 41.6% in the intermediate group and 46.9% in the low group (P < .001), according to the researchers.
The results were consistent regardless of diabetes status.
Spreen and colleagues calculated an adjusted HR of 2.93 (P < .001) for death or amputation in patients with CLI and high or immeasurable ankle-brachial index, and they determined that adding high or immeasurable ankle-brachial index as a factor to the PREVENT III model produced a net reclassification index of 0.38 (P < .0001).
“A high/immeasurable [ankle-brachial index] in patients with CLI and proven atherosclerotic obstructive disease is an independent predictor for the risk of major amputation and poor [amputation-free survival]. This increased risk is observed in patients with and without diabetes,” the researchers wrote. “Clinicians should actively search for a high/immeasurable [ankle-brachial index].” – by Erik Swain
Disclosures: Spreen reports he received a consultant fee from Boston Scientific. Another author reports he received speaking and consultant fees from Boston Scientific, Cardinal Health and Cook Medical.
Click Here to Manage Email Alerts