Prognostic value of the ankle‐brachial index in elderly patients with a stable chronic cardiovascular event

Summary. Background and Objectives: Patients with polyvascular arterial disease have a greater risk of suffering a new atherothrombotic episode than those with involvement of only one vascular territory. We have studied the predictive prognostic value of the detection of non‐diagnosed peripheral arterial disease, determined by measuring the ankle‐brachial index in a population of elderly patients with stable chronic cardiac or cerebrovascular disease. Methods: This was a multicenter, prospective cohort study with consecutive inclusion of patients between 65 and 85 years of age with a previous atherothrombotic event, but without previously established peripheral arterial disease. Results: A total of 1096 patients were evaluated during 11.7 (± 2.2) months of follow‐up. An ankle‐brachial index of < 0.9 was observed in 29.9% and > 1.4 in 6.9%. The detection of an ankle‐brachial index < 0.9 was clearly associated with the presence of a combined primary event of cardiovascular death and non‐fatal cardiovascular event [HR 1.99 (95% CI, 1.49–2.66; P < 0.001)]. There was also a significant relationship between ankle‐brachial index > 1.4 and total (P = 0.001) or cardiovascular (P = 0.020) deaths. The predictive value of both ranges of the ankle‐brachial index was maintained after adjusting for age, sex, diabetes mellitus, vascular territory, macroalbuminuria or glomerular filtration rate. Conclusions: The detection of non‐diagnosed peripheral arterial disease in patients with stable coronary or cerebrovascular events identifies a very high risk population that might benefit from more intensive treatment.