Low Ankle-Brachial Index predicts early risk of recurrent stroke in patients with acute cerebral ischemia

Georgios Tsivgoulis, Chrysi Bogiatzi, Ioannis Heliopoulos, Konstantinos Vadikolias, Eleni Boutati, Soultana Tsakaldimi, Omar S. Al-Attas, Paris Charalampidis, Charitomeni Piperidou, Efstratios Maltezos, Nikolaos Papanas

Research output: Contribution to journalArticle

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Abstract

Objective: Low Ankle-Brachial Blood Pressure Index (ABI) identifies patients with symptomatic and asymptomatic peripheral arterial disease (PAD). We sought to investigate the association of low ABI with early risk of stroke recurrence in patients with acute cerebral ischemia (ACI) and without history of symptomatic PAD. Methods: Consecutive patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) and no previous history of PAD were prospectively evaluated with ABI measurements. Demographic characteristics, vascular risk factors and secondary prevention therapies were documented. An ABI ≤0.90 in either leg was considered as evidence of asymptomatic PAD, and an ABI >0.90 was considered as normal. Patients with elevated ABI (>1.30) were excluded. The outcome of interest was recurrent stroke during 30-day follow-up. Results: A total of 176 patients with acute cerebral ischemia (mean age 64 ± 14 years, 59.1% men, 76.7% AIS) were evaluated. Asymptomatic PAD was detected in 14.8% (95%CI: 10.2-20.8%) of the studied population. The following factors were independently associated with low ABI on multivariate logistic regression models, after adjustment for potential confounders: coronary artery disease (p=0.008), diabetes mellitus (p=0.017) and increasing age (p=0.042). The cumulative 30-day recurrence rate was higher in patients with low ABI (19.2%; 95%CI: 4.1-34.3) compared to the rest (3.3%; 95%CI: 0.4-6.2%; p=0.001). Atherothrombotic stroke (ASCO grade I; p<0.001), increasing age (p=0.002) and low ABI (p=0.004) were independent predictors of stroke recurrence on multivariate Cox regression models adjusting for confounders. Conclusions: Low ABI appears to be associated with a higher risk of early recurrent stroke in patients with ACI and no history of symptomatic PAD.

Original languageEnglish (US)
Pages (from-to)407-412
Number of pages6
JournalAtherosclerosis
Volume220
Issue number2
DOIs
StatePublished - Feb 1 2012
Externally publishedYes

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Ankle Brachial Index
Brain Ischemia
Ankle
Arm
Stroke
Blood Pressure
Peripheral Arterial Disease
Recurrence
Logistic Models
Transient Ischemic Attack
Secondary Prevention
Proportional Hazards Models
Coronary Artery Disease
Leg
Diabetes Mellitus
Demography

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Low Ankle-Brachial Index predicts early risk of recurrent stroke in patients with acute cerebral ischemia. / Tsivgoulis, Georgios; Bogiatzi, Chrysi; Heliopoulos, Ioannis; Vadikolias, Konstantinos; Boutati, Eleni; Tsakaldimi, Soultana; Al-Attas, Omar S.; Charalampidis, Paris; Piperidou, Charitomeni; Maltezos, Efstratios; Papanas, Nikolaos.

In: Atherosclerosis, Vol. 220, No. 2, 01.02.2012, p. 407-412.

Research output: Contribution to journalArticle

Tsivgoulis, G, Bogiatzi, C, Heliopoulos, I, Vadikolias, K, Boutati, E, Tsakaldimi, S, Al-Attas, OS, Charalampidis, P, Piperidou, C, Maltezos, E & Papanas, N 2012, 'Low Ankle-Brachial Index predicts early risk of recurrent stroke in patients with acute cerebral ischemia', Atherosclerosis, vol. 220, no. 2, pp. 407-412. https://doi.org/10.1016/j.atherosclerosis.2011.11.009
Tsivgoulis, Georgios ; Bogiatzi, Chrysi ; Heliopoulos, Ioannis ; Vadikolias, Konstantinos ; Boutati, Eleni ; Tsakaldimi, Soultana ; Al-Attas, Omar S. ; Charalampidis, Paris ; Piperidou, Charitomeni ; Maltezos, Efstratios ; Papanas, Nikolaos. / Low Ankle-Brachial Index predicts early risk of recurrent stroke in patients with acute cerebral ischemia. In: Atherosclerosis. 2012 ; Vol. 220, No. 2. pp. 407-412.
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abstract = "Objective: Low Ankle-Brachial Blood Pressure Index (ABI) identifies patients with symptomatic and asymptomatic peripheral arterial disease (PAD). We sought to investigate the association of low ABI with early risk of stroke recurrence in patients with acute cerebral ischemia (ACI) and without history of symptomatic PAD. Methods: Consecutive patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) and no previous history of PAD were prospectively evaluated with ABI measurements. Demographic characteristics, vascular risk factors and secondary prevention therapies were documented. An ABI ≤0.90 in either leg was considered as evidence of asymptomatic PAD, and an ABI >0.90 was considered as normal. Patients with elevated ABI (>1.30) were excluded. The outcome of interest was recurrent stroke during 30-day follow-up. Results: A total of 176 patients with acute cerebral ischemia (mean age 64 ± 14 years, 59.1{\%} men, 76.7{\%} AIS) were evaluated. Asymptomatic PAD was detected in 14.8{\%} (95{\%}CI: 10.2-20.8{\%}) of the studied population. The following factors were independently associated with low ABI on multivariate logistic regression models, after adjustment for potential confounders: coronary artery disease (p=0.008), diabetes mellitus (p=0.017) and increasing age (p=0.042). The cumulative 30-day recurrence rate was higher in patients with low ABI (19.2{\%}; 95{\%}CI: 4.1-34.3) compared to the rest (3.3{\%}; 95{\%}CI: 0.4-6.2{\%}; p=0.001). Atherothrombotic stroke (ASCO grade I; p<0.001), increasing age (p=0.002) and low ABI (p=0.004) were independent predictors of stroke recurrence on multivariate Cox regression models adjusting for confounders. Conclusions: Low ABI appears to be associated with a higher risk of early recurrent stroke in patients with ACI and no history of symptomatic PAD.",
author = "Georgios Tsivgoulis and Chrysi Bogiatzi and Ioannis Heliopoulos and Konstantinos Vadikolias and Eleni Boutati and Soultana Tsakaldimi and Al-Attas, {Omar S.} and Paris Charalampidis and Charitomeni Piperidou and Efstratios Maltezos and Nikolaos Papanas",
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T1 - Low Ankle-Brachial Index predicts early risk of recurrent stroke in patients with acute cerebral ischemia

AU - Tsivgoulis, Georgios

AU - Bogiatzi, Chrysi

AU - Heliopoulos, Ioannis

AU - Vadikolias, Konstantinos

AU - Boutati, Eleni

AU - Tsakaldimi, Soultana

AU - Al-Attas, Omar S.

AU - Charalampidis, Paris

AU - Piperidou, Charitomeni

AU - Maltezos, Efstratios

AU - Papanas, Nikolaos

PY - 2012/2/1

Y1 - 2012/2/1

N2 - Objective: Low Ankle-Brachial Blood Pressure Index (ABI) identifies patients with symptomatic and asymptomatic peripheral arterial disease (PAD). We sought to investigate the association of low ABI with early risk of stroke recurrence in patients with acute cerebral ischemia (ACI) and without history of symptomatic PAD. Methods: Consecutive patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) and no previous history of PAD were prospectively evaluated with ABI measurements. Demographic characteristics, vascular risk factors and secondary prevention therapies were documented. An ABI ≤0.90 in either leg was considered as evidence of asymptomatic PAD, and an ABI >0.90 was considered as normal. Patients with elevated ABI (>1.30) were excluded. The outcome of interest was recurrent stroke during 30-day follow-up. Results: A total of 176 patients with acute cerebral ischemia (mean age 64 ± 14 years, 59.1% men, 76.7% AIS) were evaluated. Asymptomatic PAD was detected in 14.8% (95%CI: 10.2-20.8%) of the studied population. The following factors were independently associated with low ABI on multivariate logistic regression models, after adjustment for potential confounders: coronary artery disease (p=0.008), diabetes mellitus (p=0.017) and increasing age (p=0.042). The cumulative 30-day recurrence rate was higher in patients with low ABI (19.2%; 95%CI: 4.1-34.3) compared to the rest (3.3%; 95%CI: 0.4-6.2%; p=0.001). Atherothrombotic stroke (ASCO grade I; p<0.001), increasing age (p=0.002) and low ABI (p=0.004) were independent predictors of stroke recurrence on multivariate Cox regression models adjusting for confounders. Conclusions: Low ABI appears to be associated with a higher risk of early recurrent stroke in patients with ACI and no history of symptomatic PAD.

AB - Objective: Low Ankle-Brachial Blood Pressure Index (ABI) identifies patients with symptomatic and asymptomatic peripheral arterial disease (PAD). We sought to investigate the association of low ABI with early risk of stroke recurrence in patients with acute cerebral ischemia (ACI) and without history of symptomatic PAD. Methods: Consecutive patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) and no previous history of PAD were prospectively evaluated with ABI measurements. Demographic characteristics, vascular risk factors and secondary prevention therapies were documented. An ABI ≤0.90 in either leg was considered as evidence of asymptomatic PAD, and an ABI >0.90 was considered as normal. Patients with elevated ABI (>1.30) were excluded. The outcome of interest was recurrent stroke during 30-day follow-up. Results: A total of 176 patients with acute cerebral ischemia (mean age 64 ± 14 years, 59.1% men, 76.7% AIS) were evaluated. Asymptomatic PAD was detected in 14.8% (95%CI: 10.2-20.8%) of the studied population. The following factors were independently associated with low ABI on multivariate logistic regression models, after adjustment for potential confounders: coronary artery disease (p=0.008), diabetes mellitus (p=0.017) and increasing age (p=0.042). The cumulative 30-day recurrence rate was higher in patients with low ABI (19.2%; 95%CI: 4.1-34.3) compared to the rest (3.3%; 95%CI: 0.4-6.2%; p=0.001). Atherothrombotic stroke (ASCO grade I; p<0.001), increasing age (p=0.002) and low ABI (p=0.004) were independent predictors of stroke recurrence on multivariate Cox regression models adjusting for confounders. Conclusions: Low ABI appears to be associated with a higher risk of early recurrent stroke in patients with ACI and no history of symptomatic PAD.

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