WJCS  Vol.3 No.6 , October 2013
Importance of Ankle/Brachial Pressure Index in Saudi Patients with Coronary Artery Disease
ABSTRACT
Background: The ankle/brachial pressure index (ABPI) has been shown to be a good marker of systemic atherosclerosis and a powerful predictor of cardiovascular morbidity and mortality. The objective of this study was to determine the importance of measuring ABPI in Saudi patients with coronary artery disease (CAD). METHODS: This is a hospital based cross-sectional study which was conducted on all Saudi patients who underwent coronary angiography without symptoms of peripheral arterial disease at King Fahd Hospital of the University, Al-Khobar Saudi Arabia. All patients underwent measurement of their ABPI. The study was carried out between December 2010 and November 2011. RESULTS: During the study period, two hundred and five patients were included. Fifty-nine (28.8%) patients were Group II (ABPI ≤ 0.90) and the rest was Group I (ABPI > 0.90). Significant correlation was also found between low ABPI and the extent of CAD (mean number of arteries involved in Group I was 1.78 ± 0.83 compared to 2.10 ± 0.736 in Group II p = 0.011). Nevertheless, the correlation between low ABPI, and the severity of presentation of CAD were also significant (Incidence of myocardial infarction with congestive heart failure was 0.5% in Group I compared to 12% in Group II p < 0.001). CONCLUSION: The ABPI is an important prognostic indicator for Saudi patients with CAD.

Cite this paper
A. M. Alshehri and M. Elsharawy, "Importance of Ankle/Brachial Pressure Index in Saudi Patients with Coronary Artery Disease," World Journal of Cardiovascular Surgery, Vol. 3 No. 6, 2013, pp. 181-185. doi: 10.4236/wjcs.2013.36036.
References
[1]   D. L. Bhatt, P. G. Steg, E. M. Ohman, A. T. Hirsch, Y. Ikeda, J. L. Mas, et al., “REACH Registry Investigators International Prevalence, Recognition, and Treatment of Cardiovascular Risk Factors in Outpatients with Atherothrombosis,” JAMA, Vol. 295, No. 2, 2006, pp. 180-189. http://dx.doi.org/10.1001/jama.295.2.180

[2]   P. G. Steg, D. L. Bhatt, P. W. Wilson, R. Sr. D’Agostino, E. M. Ohman, J. Rother, et al. (REACH Registry Investigators), “One-Year Cardiovascular Event Rates in Out-patients with Atherothrombosis,” JAMA, Vol. 297, No. 11, 2007, pp. 1197-1206. http://dx.doi.org/10.1001/jama.297.11.1197

[3]   D. L. Bhatt, “Diffuse Coronary Disease and Atherothrombosis: A Rationale for Long-Term Therapy to Prevent Recurrent Ischemic Events,” Journal of Invasive Cardiology, Vol. 15, Suppl. B, 2003, pp. 3B-9B.

[4]   P. Poredos and B. Jug, “The Prevalence of Peripheral Arterial Disease in High Risk Subjects and Coronary or Cerebrovascular Patients,” Angiology, Vol. 58, No. 3, 2007, pp. 309-315. http://dx.doi.org/10.1177/0003319707302494

[5]   K. I. Paraskevas, D. P. Mikhailidis and C. D. Liapis, “Internal Carotid Artery Occlusion: Association with Atherosclerotic Disease in Other Arterial Beds and Vascular Risk Factors,” Angiology, Vol. 58, No. 3, 2007, pp. 329-335. http://dx.doi.org/10.1177/0003319707301754

[6]   G. Romano, E. Corrado, I. Muratori, G. Novo, G. Andolina, V. Cospite, et al., “Carotid and Peripheral Atherosclerosis in Patients Who Underwent Primary Percutaneous Coronary Intervention and Outcome Associated with Multifocal Atherosclerosis,” International Journal of Angiology, Vol. 25, No. 4, 2006, pp. 389-394.

[7]   M. A. Elsharawy, A. H. Alkhadra, M. F. Abdulmohsen and A. Bahnassy, “Impact of Atherosclerotic Risk Factors on the Extent of Arterial Occlusive Disease among Arab Patients. A Hospital Based Study,” International Journal of Angiology, Vol. 28, No. 5, 2009, pp. 367-372.

[8]   L. Missault, C. Krygier, G. Lukito and L. Mary-Rabine (OPERA Investigators Study Group), “Occurrence of Peripheral Arterial Disease in a Belgian Cohort of Patients with Cardiovascular History of Atherothrombosis,” Acta Chirurgica Belgica, Vol. 107, No. 5, 2007, pp. 508-514.

[9]   R. S. Dieter, J. Tomasson, T. Gudjonsson, R. L. Brown, M. Vitcenda, J. Einerson, et al., “Lower Extremity Peripheral Arterial Disease in Hospitalized Patients with Coronary Artery Disease,” Vascular Medicine, Vol. 8, No. 4, 2003, pp. 233-236. http://dx.doi.org/10.1191/1358863x03vm506ra

[10]   J. A. Carbayo, J. A. Divisón, J. Escribano, J. López-Abril, E. L. de Coca, L. M. Artigao, E. Martínez, C. Sanchis, J. Massó and L. Carrión (Grupo de Enfermedades Vasculares de Albacete (GEVA)), “Using Ankle-Brachial Index to Detect Peripheral Arterial Disease: Prevalence and Associated Risk Factors in a Random Population Sample,” Nutrition, Metabolism & Cardiovascular Diseases, Vol. 17, No. 1, 2007, pp. 41-49. http://dx.doi.org/10.1016/j.numecd.2005.08.009

[11]   J. J. Mourad, P. Cacoub, J. P. Collet, et al. (On Behalf of the ESC), “Study I. Screening of Unrecognized Peripheral Arterial Disease (PAD) Using Ankle-Brachial Index in High Cardiovascular Risk Patients Free from Symptomatic PAD,” Journal of Vascular Surgery, Vol. 50, No. 3, 2009, pp. 572-580. http://dx.doi.org/10.1016/j.jvs.2009.04.055

[12]   J. Ness and W. S. Aronow, “Prevalence of Coexistence of Coronary Artery Disease, Ischemic Stroke, and Peripheral Arterial Disease in Older Persons, Mean Age 80 Years, in an Academic Hospital-Based Geriatrics Practice,” Journal of the American Geriatrics Society, Vol. 47, No. 10, 1999, pp. 1255-1256.

[13]   J. Saw, D. L. Bhatt, D. J. Moliterno, et al., “The Influence of Peripheral Arterial Disease on Outcomes: A Pooled Analysis of Mortality in Eight Large Randomized Percutaneous Coronary Intervention Trials,” Journal of the American College of Cardiology, Vol. 48, No. 8, 2006, pp. 1567-1572. http://dx.doi.org/10.1016/j.jacc.2006.03.067

[14]   P. Poredos and B. Jug, “The Prevalence of Peripheral Arterial Disease in High Risk Subjects and Coronary or Cerebrovascular Patients,” Angiology, Vol. 58, No. 3, 2007, pp. 309-315. http://dx.doi.org/10.1177/0003319707302494

[15]   A. T. Hirsch, M. H. Criqui, D. Treat-Jacobson, et al., “Peripheral Arterial Disease Detection, Awareness, and Treatment in Primary Care,” JAMA, Vol. 286, No. 11, 2001, pp. 1317-1324. http://dx.doi.org/10.1001/jama.286.11.1317

[16]   R. S. Dieter, J. Tomasson, T. Gudjonsson, et al., “Lower Extremity Peripheral Arterial Disease in Hospitalized Patients with Coronary Artery Disease,” Vascular Medicine, Vol. 8, No. 4, 2003, pp. 233-236. http://dx.doi.org/10.1191/1358863x03vm506ra

[17]   J. J. Mourad, P. Cacoub, J. P. Collet, et al. (On Behalf of the ESC), “Study I. Screening of Unrecognized Peripheral Arterial Disease (PAD) Using Ankle-Brachial Index in High Cardiovascular Risk Patients Free from Symptomatic PAD,” Journal of Vascular Surgery, Vol. 50, No. 3, 2009, pp. 572-580. http://dx.doi.org/10.1016/j.jvs.2009.04.055

[18]   P. Cacoub, J. P. Cambou, S. Kownator, et al., “Prevalence of Peripheral Arterial Disease in High-Risk Patients Using Ankle-Brachial Index in General Practice: A Cross-Sectional Study,” International Journal of Clinical Practice, Vol. 63, No. 1, 2009, pp. 63-70. http://dx.doi.org/10.1111/j.1742-1241.2008.01953.x

[19]   W. B. Kannel and D. L. McGee, “Update on Some Epidemiologic Features of Intermittent Claudication: The Framingham Study,” Journal of the American Geriatrics Society, Vol. 33, No. 1, 1985, pp. 13-18.

[20]   J. A. Dormandy and R. B. Rutherford, “Management of Peripheral Arterial Disease. TASC Working Group. Trans-Atlantic Inter-Society Consensus (TASC),” Journal of Vascular Surgery, Vol. 31, No. 1, 2000, pp. S1-S296.

[21]   C. Margeta, A. Giurgea, A. Hammer, et al., “Impact of International Guidelines on the Management of Cardiovascular Risk Factors in Diabetic Patients with Peripheral Arterial Disease,” International Journal of Angiology, Vol. 28, No. 3, 2009, pp. 175-180.

[22]   C. Guijarro, N. Mesa, J. Jiménez, E. Puras, C. Sánchez, F. J. Fernández-Sánchez, et al. (AIRVAG Study Researchers), “Similarities and Differences among Patients with Symptomatic Atherosclerosis Affecting Several Territories. The AIRVAG Cohort (Integral Attention to Global Vascular Risk),” Medicina Clínica, Vol. 127, No. 16, 2006, pp. 605-611. http://dx.doi.org/10.1157/13094417

[23]   K. Wattanakit, A. R. Folsom, E. Selvin, B. D. Weatherley, J. S. Pankow, F. L. Brancati, et al., “Risk Factors for Peripheral Arterial Disease Incidence in Persons with Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study,” Atherosclerosis, Vol. 180, No. 2, 2005, pp. 389-397. http://dx.doi.org/10.1016/j.atherosclerosis.2004.11.024

[24]   R. S. Dieter, J. Tomasson, T. Gudjonsson, R. L. Brown, M. Vitcenda, J. Einerson, et al., “Lower Extremity Peripheral Arterial Disease in Hospitalized Patients with Coronary Artery Disease,” Vascular Medicine, Vol. 8, No. 4, 2003, pp. 233-236. http://dx.doi.org/10.1191/1358863x03vm506ra

[25]   J. D. Hooi, A. D. Kester, H. E. Stoffers, M. M. Overdijk, J. W. van Ree and J. A. Knottnerus, “Incidence of and Risk Factors for Asymptomatic Peripheral Arterial Occlusive Disease: A Longitudinal Study,” American Journal of Epidemiology, Vol. 153, No. 7, 2001, pp. 666-672. http://dx.doi.org/10.1093/aje/153.7.666

[26]   T. A. Elhadd, A. A. Al-Amoudi and A. S. Alzahrani, “Epidemiology, Clinical and Complications Profile of Diabetes in Saudi Arabia: A Review,” Annals of Saudi Medicine, Vol. 27, No. 4, 2007, pp. 241-250. http://dx.doi.org/10.4103/0256-4947.51484

[27]   S. O. Al-Sheikh, B. A. Aljabri, L. A. Al-Ansary, L. A. Al-Khayal, M. M. Al-Salman and M. A. Al-Omran, “Prevalence of and Risk Factors for Peripheral Arterial Disease in Saudi Arabia. A Pilot Cross-Sectional Study,” Saudi Medical Journal, Vol. 28, No. 3, 2007, pp. 412-414.

[28]   F. G. Fowkes, E. Housley, R. A. Riemersma, et al., “Smoking, Lipids, Glucose Intolerance, and Blood Pressure as Risk Factors for Peripheral Atherosclerosis Compared with Ischemic Heart Disease in the Edinburgh Artery Study,” American Journal of Epidemiology, Vol. 135, No. 4, 1992, pp. 331-340.

[29]   R. E. Maser, S. K. Wolfson Jr., D. Ellis, E. A. Stein, A. L. Drash, D. J. Becker, et al., “Cardiovascular Disease and Arterial Calcification in Insulin-Dependent Diabetes Mellitus: Interrelations and Risk Factor Profiles. Pittsburgh Epidemiology of Diabetes Complications Study-V,” Arteriosclerosis, Thrombosis, and Vascular Biology, Vol. 11, 1991, pp. 958-965. http://dx.doi.org/10.1161/01.ATV.11.4.958

[30]   J. J. Belch, E. J. Topol, G. Agnelli, et al., “Critical Issues in Peripheral Arterial Disease Detection and Management: A Call to Action,” Archives of Internal Medicine, Vol. 163, No. 8, 2003, pp. 884-892. http://dx.doi.org/10.1001/archinte.163.8.884

[31]   P. Poredos and B. Jug, “The Prevalence of Peripheral Arterial Disease in High Risk Subjects and Coronary or Cerebrovascular Patients,” Angiology, Vol. 58, No. 3, 2007, pp. 309-315. http://dx.doi.org/10.1177/0003319707302494

[32]   I. D. J. M. Moussa, R. Mehran, W. Gray, et al., “Prevalence and Prediction of Previously Unrecognized Peripheral Arterial Disease in Patients with Coronary Artery Disease: The Peripheral Arterial Disease in Interventional Patients Study,” Catheterization and Cardiovascular Interventions, Vol. 73, No. 6, 2009, pp. 719-724. http://dx.doi.org/10.1002/ccd.21969

[33]   S. T. Chang, C. L. Chen, C. M. Chu, P. C. Lin, C. M. Chung, J. T. Hsu, H. W. Cheng, T. Y. Yang and K. C. Hung, “Ankle-Arm Index Is a Useful Test for Clinical Practice in Outpatients with Suspected Coronary Artery Disease,” Circulation Journal, Vol. 70, No. 6, 2006, pp. 686-690. http://dx.doi.org/10.1253/circj.70.686

[34]   H. E. Resnick, R. S. Lindsay, M. M. McDermott, et al., “Relationship of High and Low Ankle Brachial Index to All-Cause and Cardiovascular Disease Mortality: The Strong Heart Study,” Circulation, Vol. 109, No. 6, 2004, pp. 733-739. http://dx.doi.org/10.1161/01.CIR.0000112642.63927.54

 
 
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