Ankle‐Brachial Index and Subsequent Risk of Severe Ischemic Leg Outcomes: The ARIC Study

Background Ankle‐brachial index (ABI) is used to identify lower‐extremity peripheral artery disease (PAD). However, its association with severe ischemic leg outcomes (eg, amputation) has not been investigated in the general population. Methods and Results Among 13 735 ARIC (Atherosclerosis Risk in C...

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Autores principales:	Amy Paskiewicz, Frances M. Wang, Chao Yang, Shoshana H. Ballew, Corey A. Kalbaugh, Elizabeth Selvin, Maya Salameh, Gerardo Heiss, Josef Coresh, Kunihiro Matsushita
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	amputation ankle‐brachial index peripheral artery disease prognosis Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/ae755040a5e04eb682d3173f00b99b39
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spelling	oai:doaj.org-article:ae755040a5e04eb682d3173f00b99b392021-11-16T10:22:43ZAnkle‐Brachial Index and Subsequent Risk of Severe Ischemic Leg Outcomes: The ARIC Study10.1161/JAHA.121.0218012047-9980https://doaj.org/article/ae755040a5e04eb682d3173f00b99b392021-11-01T00:00:00Zhttps://www.ahajournals.org/doi/10.1161/JAHA.121.021801https://doaj.org/toc/2047-9980Background Ankle‐brachial index (ABI) is used to identify lower‐extremity peripheral artery disease (PAD). However, its association with severe ischemic leg outcomes (eg, amputation) has not been investigated in the general population. Methods and Results Among 13 735 ARIC (Atherosclerosis Risk in Communities) study participants without clinical manifestations of PAD (mean age, 54 [SD, 5.8] years; 44.4% men; and 73.6% White) at baseline (1987–1989), we quantified the prospective association between ABI and subsequent severe ischemic leg outcomes, critical limb ischemia (PAD with rest pain or tissue loss) and ischemic leg amputation (PAD requiring amputation) according to discharge diagnosis. Over a median follow‐up of ≈28 years, there were 221 and 129 events of critical limb ischemia and ischemic leg amputation, respectively. After adjusting for demographics, ABI ≤0.90 versus 1.11 to 1.20 had a ≈4‐fold higher risk of critical limb ischemia and ischemic leg amputation (hazard ratios, 3.85 [95% CI, 2.09–7.11] and 4.39 [95% CI, 2.08–9.27]). The magnitude of the association was modestly attenuated after multivariable adjustment (hazard ratios, 2.44 [95% CI, 1.29–4.61] and 2.72 [95% CI, 1.25–5.91], respectively). ABI 0.91 to 1.00 and 1.01 to 1.10 were also associated with these severe leg outcomes, with hazard ratios ranging from 1.7 to 2.0 after accounting for potential clinical and demographic confounders. The associations were largely consistent across various subgroups. Conclusions In a middle‐aged community‐based cohort, lower ABI was independently and robustly associated with increased risk of severe ischemic leg outcomes. Our results further support ABI ≤0.90 as a threshold diagnosing PAD and also suggest the importance of recognizing the prognostic value of ABI 0.91 to 1.10 for limb prognosis.Amy PaskiewiczFrances M. WangChao YangShoshana H. BallewCorey A. KalbaughElizabeth SelvinMaya SalamehGerardo HeissJosef CoreshKunihiro MatsushitaWileyarticleamputationankle‐brachial indexperipheral artery diseaseprognosisDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 10, Iss 22 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	amputation ankle‐brachial index peripheral artery disease prognosis Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	amputation ankle‐brachial index peripheral artery disease prognosis Diseases of the circulatory (Cardiovascular) system RC666-701 Amy Paskiewicz Frances M. Wang Chao Yang Shoshana H. Ballew Corey A. Kalbaugh Elizabeth Selvin Maya Salameh Gerardo Heiss Josef Coresh Kunihiro Matsushita Ankle‐Brachial Index and Subsequent Risk of Severe Ischemic Leg Outcomes: The ARIC Study
description	Background Ankle‐brachial index (ABI) is used to identify lower‐extremity peripheral artery disease (PAD). However, its association with severe ischemic leg outcomes (eg, amputation) has not been investigated in the general population. Methods and Results Among 13 735 ARIC (Atherosclerosis Risk in Communities) study participants without clinical manifestations of PAD (mean age, 54 [SD, 5.8] years; 44.4% men; and 73.6% White) at baseline (1987–1989), we quantified the prospective association between ABI and subsequent severe ischemic leg outcomes, critical limb ischemia (PAD with rest pain or tissue loss) and ischemic leg amputation (PAD requiring amputation) according to discharge diagnosis. Over a median follow‐up of ≈28 years, there were 221 and 129 events of critical limb ischemia and ischemic leg amputation, respectively. After adjusting for demographics, ABI ≤0.90 versus 1.11 to 1.20 had a ≈4‐fold higher risk of critical limb ischemia and ischemic leg amputation (hazard ratios, 3.85 [95% CI, 2.09–7.11] and 4.39 [95% CI, 2.08–9.27]). The magnitude of the association was modestly attenuated after multivariable adjustment (hazard ratios, 2.44 [95% CI, 1.29–4.61] and 2.72 [95% CI, 1.25–5.91], respectively). ABI 0.91 to 1.00 and 1.01 to 1.10 were also associated with these severe leg outcomes, with hazard ratios ranging from 1.7 to 2.0 after accounting for potential clinical and demographic confounders. The associations were largely consistent across various subgroups. Conclusions In a middle‐aged community‐based cohort, lower ABI was independently and robustly associated with increased risk of severe ischemic leg outcomes. Our results further support ABI ≤0.90 as a threshold diagnosing PAD and also suggest the importance of recognizing the prognostic value of ABI 0.91 to 1.10 for limb prognosis.
format	article
author	Amy Paskiewicz Frances M. Wang Chao Yang Shoshana H. Ballew Corey A. Kalbaugh Elizabeth Selvin Maya Salameh Gerardo Heiss Josef Coresh Kunihiro Matsushita
author_facet	Amy Paskiewicz Frances M. Wang Chao Yang Shoshana H. Ballew Corey A. Kalbaugh Elizabeth Selvin Maya Salameh Gerardo Heiss Josef Coresh Kunihiro Matsushita
author_sort	Amy Paskiewicz
title	Ankle‐Brachial Index and Subsequent Risk of Severe Ischemic Leg Outcomes: The ARIC Study
title_short	Ankle‐Brachial Index and Subsequent Risk of Severe Ischemic Leg Outcomes: The ARIC Study
title_full	Ankle‐Brachial Index and Subsequent Risk of Severe Ischemic Leg Outcomes: The ARIC Study
title_fullStr	Ankle‐Brachial Index and Subsequent Risk of Severe Ischemic Leg Outcomes: The ARIC Study
title_full_unstemmed	Ankle‐Brachial Index and Subsequent Risk of Severe Ischemic Leg Outcomes: The ARIC Study
title_sort	ankle‐brachial index and subsequent risk of severe ischemic leg outcomes: the aric study
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/ae755040a5e04eb682d3173f00b99b39
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Ankle‐Brachial Index and Subsequent Risk of Severe Ischemic Leg Outcomes: The ARIC Study

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