Screening of unrecognized peripheral arterial disease (PAD) using ankle-brachial index in high cardiovascular risk patients free from symptomatic PAD
Received 25 February 2009; accepted 21 April 2009. published online 29 June 2009.
Objective
To determine the utility of ankle-brachial index (ABI) in screening for unrecognized peripheral arterial disease (PAD). Although PAD is a consistent predictor of cardiovascular morbidity and mortality, it is often under-diagnosed and under-treated.
Methods
In this prospective, observational, real-life, epidemiologic study (ELLIPSE) the prevalence of PAD (ABI < 0.9) was calculated in 2146 asymptomatic patients ≥55 years of age who were at high cardiovascular risk and who were hospitalized in departments of cardiology, diabetology, geriatrics, internal medicine, or neurology in metropolitan France. Univariate and multivariate analyses were performed to identify PAD risk factors. The discriminatory power of the model was evaluated by calculating the area under the curve (AUC) of the receiver operating characteristic curve.
Results
The ABI was <0.9 in 41.1% of patients. In the multivariate analysis, absence of ≥1 pulse (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.81 to 2.63; P < .0001), arterial bruit (OR, 1.92; 95%CI, 1.34 to 2.75; P < .0004), previous non-Q-wave myocardial infarction (OR, 1.50; 95%CI, 1.08 to 2.08; P = .02), regular smoking (OR, 1.49; 95%CI, 1.22 to 1.80; P < .0001), age ≥81 years (OR, 1.45; 95%CI, 1.15 to 1.82; P = .001), creatinine clearance <60 mL/min (OR, 1.33; 95%CI, 1.08 to 1.63; P = .008), and treated hypertension (OR, 1.28; 95%CI, 1.03 to 1.59; P = .03) were significantly associated with PAD. Although risk increased with the number of variables, the model, based on clinical symptoms and on medical history parameters, was not discriminatory (AUC = 0.66). On average, physicians took 15 minutes to perform the ABI test.
Conclusions
The high prevalence of asymptomatic PAD in this patient population suggests that ABI should systematically be performed in high-risk hospitalized patients to ensure that appropriate secondary prevention programs are initiated.
aDepartment of Internal Medicine, Avicenne University Hospital – AP-HP and Paris 13 University, Bobigny, France
bDepartment of Internal Medicine, AP-HP, Hospital La Pitié Salpetrière and Paris 6 University, Paris, France
cDepartment of Cardiology, Pitié-Salpétrière Hospital–APHP, Paris, France
dDepartment of Angiology and Haemostasis, HUG, Genève, Switzerland
eDepartment of Neurology, Pontchaillou Hospital, Rennes, France
fDepartment of Diabetology Saint-Joseph Hospital, Paris, France
gDepartment of Vascular Medicine, South Hospital, Amiens, France
hDepartment of Vascular Medicine, Saint-Joseph Hospital, Paris, France
Reprint requests: Jean-Jacques Mourad, MD, PhD, Department of Internal Medicine, Avicenne Hospital, 125 rue de Stalingrad, 93009 Bobigny, cx 09, France
Competition of interest: The authors received honorarium for their consultancies from Sanofi-Aventis France and Bristol-Myers Squibb.
Supported by Sanofi-aventis France and Bristol-Myers Squibb.
ABSTRACT