Prognostic value of an abnormal ankle-brachial index in patients receiving drug-eluting stents

Advanced atherosclerotic disease increases the risk of stent thrombosis after drug-eluting stent (DES) implantation. We aimed to determine if an abnormal ankle-brachial index (ABI) value as a surrogate of atherosclerotic disease and vascular inflammation provides information on 1-year risk of cardiovascular events after DES implantation. A prospective cohort of 1,437 consecutive patients undergoing DES implantation from January through April 2008 in 26 Spanish hospitals was examined. ABI was calculated by Doppler in a standardized manner. Patients were followed to 12 months after the percutaneous coronary intervention to determine total and cardiovascular mortality, stroke, nonfatal acute coronary syndrome (ACS), and new revascularizations. Association of an abnormal ABI value (i.e., ≤ 0.9 or ≥ 1.4) with outcomes was assessed by conventional logistic regression and by propensity-score analysis. Patients with abnormal ABI values (n = 582, 40.5%) in general had higher global cardiovascular risk, the reason for DES implantation was more often ACS, and had a higher rate of complications during admission (heart failure or stroke or major hemorrhage 11.3% vs 5.3%, p <0.001). An abnormal ABI value was independently associated with 1-year total mortality (odds ratio 2.23, 95% confidence interval 1.13 to 4.4) and cardiovascular mortality (odds ratio 2.06, 95% confidence interval 1.04 to 4.22). No independent association was found between an abnormal ABI value and 1-year nonfatal ACS, stroke, and new revascularizations. In conclusion, although an abnormal ABI value was associated with fatal outcomes in patients receiving DESs, no association was found with nonfatal ACS and new revascularizations. A clear relation between abnormal ABI and surrogates of DES thrombosis could not be established.     

Prognostic value of estimated glomerular filtration rate in hospitalized elderly patients

A multicenter observational study, REPOSI (REgistro POliterapie Società Italiana di Medicina Interna), was conducted to assess the prognostic value of glomerular filtration rate (eGFR) on in-hospital mortality, hospital re-admission and death within 3 months, in a sample of elderly patients (n = 1,363) admitted to 66 internal medicine and geriatric wards. Based on eGFR, calculated by the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula, subjects at hospital admission were classified into three groups: group 1 with normal eGFR (≥60 ml/min/1.73 m², reference group), group 2 with moderately reduced eGFR (30–59 ml/min/1.73 m²) and group 3 with severely reduced eGFR (<30 ml/min/1.73 m²). Patients with the lowest eGFR (group 3) on admission were more likely to be older, to have a greater cognitive and functional impairment and a high rate of comorbidities. Multivariable logistic regression analysis showed that severely reduced eGFR at the time of admission was associated with in-hospital mortality (OR 3.00; 95 % CI 1.20–7.39, p = 0.0230), but not with re-hospitalization (OR 0.97; 95 % CI 0.54–1.76, p = 0.9156) or mortality at 3 months after discharge (OR 1.93; 95 % CI 0.92–4.04, p = 0.1582). On the contrary, an increased risk (OR 2.60; 95 % CI 1.13–5.98, p = 0.0813) to die within 3 months after discharge was associated with decreased eGFR measured at the time of discharge. Our study demonstrates that severely reduced eGFRs in elderly patients admitted to hospital are strong predictors of the risk of dying during hospitalization, and that this measurement at the time of discharge helps to predict early death after hospitalization.     

Prognostic value of echocardiography in hospitalized patients with pericardial effusion.

It is often difficult to predict outcome in hospitalized patients with pericardial effusion. To address this issue, the prognostic value of echocardiography was studied in 187 hospitalized patients diagnosed with pericardial effusions over a 1-year period. The index echocardiogram showed that 11 effusions were large (6%), 39 were moderate (21%), and 137 were small (73%). Right ventricular collapse was present in 7% of cases (13 of 178), right atrial collapse in 12% (21 of 168), and inferior vena cava (IVC) plethora with blunted response to respiration in 35% (46 of 132). During the course of hospitalization, 9 patients (5%) had cardiac tamponade and 16 (9%) had cardiac tamponade, pericardiocentesis and/or surgical drainage (combined end point). By univariate analysis, each echocardiographic sign was associated with both cardiac tamponade and the combined end point (p less than or equal to 0.01 for comparisons with size and right-sided chamber collapse; p less than or equal to 0.07 for comparisons with IVC plethora). When the data were analyzed with logistic regression modeling, effusion size was the most powerful predictor of outcome (cardiac tamponade: odds ratio 51, 95% confidence interval 3.5-729, p = 0.004; combined end point: odds ratio 78, 95% confidence interval 14-421, p = 0.0001), and neither right-sided chamber collapse nor IVC plethora with blunted response to respiration retained significant associations. It is concluded that echocardiographically determined effusion size is a powerful predictor of outcome in hospitalized patients with pericardial effusion, and that right-sided chamber collapse and IVC plethora with blunted response to respiration add little if any additional prognostic information.     

Correlates for a low ankle-brachial index in elderly Chinese

This study examines the prevalence of atherosclerosis (using ankle-brachial index (ABI) value <0.9) and associated socioeconomic and lifestyle factors in elderly Chinese, adjusting for presence of cardiovascular diseases and body mass index, in a cross-sectional survey of 1999 men and 1999 women aged 65 years and over living in the community. A questionnaire containing information regarding socioeconomic status, medical history and lifestyle factors was administered. Measurement included height, weight, percentage body fat using dual-energy X-ray absorptiometry and ABI. The Hong Kong population (2000) age adjusted prevalence of ABI <0.9 was 5.3% for men and 11.0% for women. In multivariate analysis, old age, female gender, presence of cardiovascular diseases, cognitive impairment, prolonged 6 m walk, smoking habit and alcohol intake were positively associated with ABI <0.9, while negative associations were observed with Vitamin C intake >100 mg per day, with the lowest OR for the range 141-190 mg (OR 0.4). Physical activity level, and self rated higher social standing in the community, while significant in univariate analysis, were not included as independent significant factors in the multivariate model. Lifestyle factors and the female gender were independent risk factors for atherosclerosis in the elderly Chinese population.     

踝肱指数高值糖尿病患者下肢动脉粥样硬化病变的超声特点

目的分析踝肱指数(ABI)高值糖尿病患者下肢动脉粥样硬化病变的超声特点。方法随机选取糖尿病患者92例,根据ABI值分为:ABI高值组(23例,ABI>1.3)、AB1正常组(39例,ABI 0.9～1.3)及ABI低值组(30例,ABI<0.9),根据下肢动脉超声结果,对下肢动脉粥样硬化病变进行分析。结果与ABI低值组比较,ABI高值组患者下肢动脉病变闭塞率明显降低(63.3%vs 4.3%,P<0.05);ABI高值组患者下肢动脉粥样硬化病变主要表现为弥漫性斑点状强回声及小斑块病变(82.6%),并且,病变主要分布于下肢远端(44.4%)。ABI正常组患者下肢动脉粥样硬化病变以近端为主(81.8%)。结论 ABI高值患者下肢动脉粥样硬化病变的临床特征与动脉内膜中层钙化的病变特征一致,表明ABI高值对糖尿病患者动脉内膜中层钙化具有较高的预测价值。     

系统性免疫炎症指数对老年心房颤动患者预后价值的研究

目的 探讨系统性免疫炎症指数(SⅡ)与老年心房颤动(房颤)患者不良预后的关系.方法 选择老年房颤患主要终点全因死亡和心源性死亡,次要终点缺血性脑卒中.结果 高SⅡ组全因死亡和心源性死亡比例明显高于低SⅡ组(14.3％vs5.3％,P＜0.01;9.3％vs 3.8％,P＜0.01).调整混杂因素后,多变量Cox回归分析...     

Prognostic value of PINI index in patients with multiple myeloma

Background: The Prognostic Inflammatory and Nutritional Index (PINI) is a simple scoring system that aggregates two blood markers of inflammatory [C‐reactive protein (CRP) and orosomucoid] and of nutritional (albumin and prealbumin) states. It is used in routine practice in geriatric medicine, especially in hospitalized elderly patients. This study was undertaken to evaluate the usefulness of PINI index in multiple myeloma (MM), a malignancy of the elderly. Method: The PINI score was determined in 231 previously untreated patients with MM, of whom 112 were ≥65 yrs old. The serum albumin, prealbumin, orosomucoid (human α1‐acid glycoprotein), and hsCRP are measured routinely by immunonephelometry. Results: In the overall population and the elderly subset, PINI ≥ 4 (‘high PINI’) was correlated with a shorter median survival, 26 vs. 65 months in the high and low PINI groups, respectively. The prognostic impact of PINI index was dramatic in the elderly MM subgroup, 6 and 45 months, respectively. The high PINI index also predicted for shorter survival in various groups with good prognostic, such as low International Staging System (ISS) stages, low b2m, and absence of del17p and t(4;14), further demonstrating its prognostic impact on overall survival. In multivariate analysis, PINI index provided additional survival prognostic information to b2m in a b2m/PINI model. Conclusion: PINI index appears to be a useful and easy‐to‐perform marker in routine to determine the prognosis of patients with MM, especially in the elderly population. PINI might represent an alternative to ISS score, especially in elderly patients, in the future.     

高血压患者踝臂指数与尿微量白蛋白的相关性

目的 探讨高血压患者踝臂指数（ABI）与尿微量白蛋白（MAU）的关系.方法 80例原发高血压患者经连续2次检查晨尿排除显性蛋白尿,采用多普勒超声法检测四肢动脉血压,计算ABI,分为ABI正常组（38例）和ABI减低组（42例）,连续2次检查晨尿常规及MAU.结果 两组MAU阳性率分别为28.9%（11/38）和54.8%（23/42）,MAU分别为（21±11）mg/L和（38±24）mg/L,差异均有统计学意义（P＜0.05）.直线相关性分析显示,ABI正常组ABI与MAU无显著相关（r＝0.18,P＞0.05）,而ABI减低组ABI与MAU呈显著负相关（r＝-0.63,P＜0.01）.结论 ABI减低的高血压患者MAU增加,提示ABI减低对评估高血压患者早期肾功能损害有参考价值.     

踝肱指数联合头颈部CT血管造影在缺血性卒中复发的预测价值

目的 探讨踝肱指数（ABI）联合头颈部CT血管造影(CTA)在缺血性卒中复发的预测价值。方法 选取广东医学院附属深圳福田人民医院神经内科于2009年1月至2011年12月缺血性卒中住院患者共465例,测量所有患者的ABI和头颈部血管CTA,观察患者出院2年内缺血性卒中复发的发生情况,对缺血性卒中复发相关危险因子进行 Logistic多因素回归分析。结果 随访2年内复发患者为102例,复发次数≥1次。随访结果发现,低ABI、颅内外动脉狭窄是缺血性卒中患者复发的独立预测因子（P值分别为0.015,0.001）;复发组ABI＜0.9的患者的比率显著高于未复发组（P=0.017）;复发组有颅内外动脉狭窄的患者的比率显著高于未复发组（P=0.001）;复发组 ABI＜0.9且有颅内外动脉狭窄的患者的比率显著高于未复发组（P<0.05）。结论 ABI及头颈部CTA改变对缺血性卒中的复发风险具有预测价值,且二者联合的预测价值更好,ABI<0.9且有颅内外动脉狭窄的缺血性卒中患者更易复发。低ABI、颅内外动脉狭窄是缺血性卒中患者复发的独立预测因子。     

A predictive index for functional decline in hospitalized elderly medical patients

Objective: To prospectively develop and validate a predictive index to identify on admission elderly hospitalized medical patients at risk for functional decline. Design: Two prospective cohort studies, in tandem. The predictive model developed in the initial cohort was subsequently validated in a separate cohort. Setting: General medical wards of a university teaching hospital. Patients: For the development cohort, 188 hospitalized general medical patients aged ≥70 years. For the validation cohort, 142 comparable patients. Measurement and main results: The subjects and their nurses were interviewed twice weekly using standardized, validated instruments. Functional decline occurred among 51/188 (27%) patients in the development cohort. Four independent baseline risk factors (RFs) for functional decline were identified: decubitus ulcer (adjusted relative risk [RR] 2.7; 95% confidence interval [CI] 1.4, 5.2); cognitive impairment (RR 1.7; CI 0.9, 3.1); functional impairment (RR 1.8; CI 1.0, 3.3); and low social activity level (RR2.4; CI 1.2, 5.1). A risk-stratification system was developed by adding the numbers of RFs. Rates of functional decline for the low- (0 RF), intermediate- (1–2 RFs), and high- (3–4 RFs) risk groups were 8%, 28%, and 63%, respectively (p<0.0001).The corresponding rates in the validation cohort, of whom 34/142 (24%) developed functional decline, were 6%, 29%, and 83% (p<0.0001). The rates of death or nursing home placement, clinical outcomes associated with functional decline in the hospital, were 6%, 19%, and 41% (p<0.002) in the development cohort and 10%, 32%, and 67% (p<0.001) in the validation cohort, respectively, for the three risk groups. Conclusions: Functional decline among hospitalized elderly patients is common, and a simple predictive model based on four risk factors can be used on admission to identify elderly persons at greatest risk. Supported in part by grants from the John A. Hartford Foundation (Grant #88345-3G), the Robert Leete and Clara Guthrie Patterson Trust, the Retirement Research Foundation (Grants #90-44, 91-66), and the Sandoz Foundation for Gerontological Research (Grants #11, 27). Dr. Inouye is a Dana Foundation Faculty Scholar and recipient of Academic Award #lK08AB00524-01 from the National Institute on Aging.     

Improving the clinical examination for a low ankle-brachial index

We sought to determine clinical examination features that predict an abnormal ankle-brachial index (ABI). Eleven United States and Canadian university-affiliated practices participated. Patients over age 55 (n=218) presenting for an outpatient appointment in a general medical clinic. We excluded patients with amputations or acute leg pain. A standard clinical examination was performed consisting of historical features and physical examination findings with Doppler ausculation. The most efficient findings were a. presence of only one Doppler-auscultated posterior tibial artery component [LR=7.0; (95% CI 4.4, 11.6)], and b. absence of a palpable pulse [LR=4.6; (95% CI 3.2, 6.6)]. We derived a score based on the number of auscultated components, grade of palpated pulse, and history of myocardial infarction (LR_score<6=7.8; LR_score≥6=0.2; c index=0.93). Clinicians required a median 2.5 min to collect the clinical information and derive the score (interquartile range 1.8 to 3.6 min), versus 8.5 min for the ABI (interquartile range 7.4 to 9.4 min). Palpation and Doppler auscultation of the posterior tibial artery, combined with knowledge of prior myocardial infarctions, were the most effective and efficient findings for patients in general medical clinics. A score based on these findings appears promising as a screening tool for a low ABI.     

Excess 1-year cardiovascular risk in elderly primary care patients with a low ankle-brachial index (ABI) and high homocysteine level

Previous studies in selected patient samples suggested a high risk for total mortality and cardiovascular (CV) morbidity associated not only with symptomatic, but also with asymptomatic peripheral arterial disease (PAD). Our aim was to assess the 1-year risk of death and CV morbidity associated with PAD in primary care. Furthermore, we quantified the strength of association between low ankle-brachial index (ABI, as indicator for PAD), plasma homocysteine (HC) levels, and various accepted PAD risk factors, and death and outcomes. In a prospective cohort study, 6880 unselected patients > or =65 years were followed up by 344 primary care physicians in Germany. At 1 year, all-cause mortality was 2.8% in patients with PAD and 0.9% in patients without PAD (odds ratio [OR] adjusted for age and gender: 2.7 [95% confidence interval: 1.7; 4.2]; multivariate adjusted OR: 2.0 [1.3; 3.3]). Mortality due to CV events was 1.6 versus 0.4% (OR: 3.7 [2.0; 6.9], adjusted OR: 2.5 [1.3; 4.9]). Patients with PAD and high HC values (> or =fourth quintile) had a markedly increased risk of premature death: OR versus no PAD/low HC level (相似文献   

The long-term prognostic value of the resting and postexercise ankle-brachial index

BACKGROUND: Peripheral arterial disease is associated with a high incidence of cardiovascular mortality. Peripheral arterial disease can be detected by using the ankle-brachial index (ABI). This study assessed the prognostic value of the postexercise ABI in addition to the resting ABI on long-term mortality in patients with suspected peripheral arterial disease. METHODS: In this prospective cohort study of 3209 patients (mean +/- SD age, 63 +/- 12 years; 71.1% male), resting and postexercise ABI values were measured and a reduction of postexercise ABI over baseline resting readings was calculated. The mean follow-up was 8 years (interquartile range, 4-11 years). RESULTS: During follow-up, 1321 patients (41.2%) died. After adjusting for clinical risk factors, lower resting ABI values (hazard ratio per 0.10 lower ABI, 1.08; 95% confidence interval [CI], 1.06-1.10), lower postexercise ABI values (hazard ratio per 0.10 lower ABI, 1.09; 95% CI, 1.08-1.11), and higher reductions of ABI values over baseline readings (hazard ratio per 10% lower ABI, 1.12; 95% CI, 1.09-1.14) were significantly associated with a higher incidence of mortality. In patients with a normal resting ABI (n = 789), a reduction of the postexercise ABI by 6% to 24%, 25% to 55%, and greater than 55% was associated with a 1.6-fold (95% CI, 1.2-2.2), 3.5-fold (95% CI, 2.4-5.0), and 4.8-fold (95% CI, 2.5-9.1) increased risk of mortality, respectively. CONCLUSIONS: Resting and postexercise ABI values are strong and independent predictors of mortality. A reduction of postexercise ABI over baseline readings can identify additional patients (who have normal ABI values at rest) at increased risk of subsequent mortality.     

Prehypertension is associated with peripheral arterial disease and low ankle-brachial index

Patients with prehypertension suffer endothelial dysfunction and are at increased cardiovascular risk. Ankle-brachial index (ABI) constitutes an efficient tool for diagnosing peripheral arterial disease; but also an ABI < 0.9 is an independent and positive predictor of endothelial dysfunction and is associated with increased cardiovascular risk and mortality.The aimof this study was testing whether ABI was decreased in prehypertensive patients when compared with normotensive subjects.MethodsWe included 70 prehypertensive patients older than 19 years, in whom the ABI was registered with a 5 megahertz Doppler (Summit Doppler L250, Life Dop., USA). The highest ankle systolic pressure was divided by the highest brachial systolic pressure. We also included 70 normotensive subjects in whom the ABI was registered in the same way. The measurements were performed by the same physician who was blinded about the study.Statistical analysis was performed with odds ratio and student t-test.ResultsThe ABI values in normotensive subjects were 1.023 ± 0.21, whereas prehypertensive patients significantly had lower ABI (0.90 ± 0.14p = 0.00012).We found ABI <0.9 in 30 prehypertensive patients (42.85%) and 13 normotensive patients (18.5%). The odds ratio of ABI <0.90 in prehypertensive patients was 3.288 (IC₉₅ 1.5–7.0, p = 0.0023).A regression analysis failed to show any independent association between ABI values and any other clinical parameter.ConclusionsPrehypertensive patients had lower ABI and higher prevalence of peripheral artery disease when compared with normotensive subjects; this fact increases their cardiovascular risk. ABI must be included in global evaluation of prehypertensive subjects.     

Prognostic value of free plasma homocysteine levels in patients hospitalized with acute coronary syndrome

Elevated total plasma homocysteine is an established risk factor for cardiovascular disease. Experimental evidence suggests that non-protein-bound free homocysteine is particularly hazardous to the vascular endothelium. This study evaluates the predictive role of free plasma homocysteine levels on cardiovascular endpoints in patients with acute coronary syndrome (ACS). In a cohort of 379 hospitalized patients with a diagnosis of myocardial infarction or unstable angina pectoris, total and free plasma homocysteine levels were measured by high performance liquid chromatography. The patients were followed for a median 2.7 years. The primary endpoint was a composite of cardiovascular death, myocardial infarction and stroke during follow-up. Stepwise Cox regression was used for multivariate analysis. Primary outcome events occurred in 82 patients (22%) with a median time to event of 6 months. The unadjusted hazard ratio for a free homocysteine level >4.11 micromol/L was 2.16 (95% confidence intervals [CI] 1.36 to 3.42) compared with the 4 lower quintiles. After adjusting for the covariates the hazard ratio was 2.25 (95% CI 1.41 to 3.58, p = 0.01). Compared with the lower 4 quintiles, patients with a total homocysteine level >22.4 micromol/L had a 2.09-fold higher risk (95% CI 1.31 to 3.35) for an event during follow-up. Adjusted for age, discharge diagnosis, serum creatinine, history of atherothrombotic events, and diabetes mellitus, the adjusted hazard ratio was 1.37 (95% CI 0.83 to 2.25, p = 0.22). In conclusion, plasma free homocysteine levels >4.11 micromol/L are a significant and independent risk factor for recurrent cardiovascular events in patients hospitalized for ACS, although total plasma homocysteine levels have no predictive value.     

踝臂指数与老年缺血性脑卒中关系的研究

目的探讨踝臂指数(ABI)与老年缺血性脑卒中的关系。方法选择74例老年缺血性脑卒中患者为病例组,其中大动脉硬化性(LAA)患者44例,小动脉闭塞型(SAO)患者30例;另选26例体检者为对照组。所有入选对象均进行ABI测量。结果与对照组比较,病例组ABI异常率明显升高(35.1%vs 7.7%,P<0.01),ABI值明显降低(0.94±0.15 vs 1.03±0.09,P<0.01);LAA患者ABI值明显低于SAO患者(0.88±0.16 vs 1.03±0.06,P<0.01)。结论 ABI与缺血性脑卒中发病有关,低ABI值增加缺血性脑卒中的风险;ABI与LAA发病有关,与SAO无关。     

高血压患者踝臂指数与冠状动脉狭窄严重程度的相关性研究

目的观察老年高血压患者踝臂指数与冠状动脉狭窄严重程度的相关性,评价踝臂指数对冠状动脉狭窄严重程度的预测价值。方法连续入选156例接受冠状动脉造影检查的老年高血压患者（年龄≥65岁）进行研究,根据冠状动脉造影结果分为无病变组（16例）、单支病变组（20例）、2支病变组（28例）、3支或左主干病变组（92例）。对所有患者进行病史采集、血液化验检查和踝臂指数测量,并对踝臂指数与冠状动脉Gensini评分做相关分析。结果踝臂指数与Gensini评分呈负相关;冠状动脉3支或左主干病变组患者踝臂指数显著降低（P〈0.01）,而造影正常、单支病变或2支病变组患者踝臂指数无显著差异;评价踝臂指数对3支或左主干病变预测价值的ROC曲线下面积为（0.79±0.036）,95%可信区间为（0.69～0.85,P〈0.001）;踝臂指数≤0.9作为截断值预测3支或左主干病变具有相对高的特异性（89.5%）和敏感性（53.6%）。结论老年高血压患者踝臂指数与冠状动脉狭窄严重程度呈负相关,踝臂指数≤0.9对预测冠状动脉3支和左主干病变具有较高的特异性和敏感性。