The ratio of ankle and arm arterial pressure as an independent predictor of mortality

doi:10.1016/0021-9150(91)90014-T

Atherosclerosis

Volume 87, Issues 2–3, April 1991, Pages 119-128

https://doi.org/10.1016/0021-9150(91)90014-T Get rights and content

Abstract

We carefully ascertained deaths for a cohort of 744 patients who had undergone noninvasive testing for lower extremity peripheral arterial disease (PAD) in a university affiliated, community hospital. Using a ratio of the ankle and brachial blood pressures (ABI) of less than 0.85 as the criteria, the relative risk (RR) for total mortality associated with PAD was 2.36 (95% CL = 1.60, 3.48) after adjusting for baseline covariates in a proportional hazards model. There was a strong trend for increasing risk with decreasing ABI (P < 0.0001). Specific causes of death for which survival was directly related to the magnitude of ABI were myocardial infarctions, and deaths other than vascular disease and cancer. There was no relationship between ABI and the risk of mortality from cancer. The mortality experience of those with normal ABI was very similar to that of the general U.S. population (age adjusted RR = 1.14, 95% CL = 0.78, 1.61), whereas the risk for those with an ABI less than 0.4 was markedly elevated in comparison to the U.S. population (RR = 4.49, 95% CL = 3.52, 5.64). Our results suggest that the relatively technically simple measure of the ratio of ankle to brachial blood pressures, if low, carries a very poor prognosis and should prompt investigation and treatment of atherosclerotic disease in other vascular systems.

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Research paperThe ratio of ankle and arm arterial pressure as an independent predictor of mortality

Abstract

J. Chron. Dis.

Surg. Clin. North Am.

J. Chron. Dis.

J. Clin. Epidemiol.

Lectures on mortification delivered at the medical theatre of St. George's Hospital, Lecture V

Cardiovascular survey methods

WHO Monogr. Ser.

Prevalence of intermittent claudication and its effect on mortality

Acta. Med. Scand.

The natural course of Arteriosclerosis of the lower extremities

Natural history of angina pectoris, possible previous myocardial infarction and intermittent claudication during the eighth decade

Acta Med. Scand.

Predisposition to atherosclerosis in the head, heart, and legs

J.A.M.A.

Intermittent claudication: factors determining outcome

Br. Med. J.

Noninvasive testing vs clinical evaluation of arterial disease

J.A.M.A.

The sensitivity, specificity, and predictive value of traditional clinic evaluation of peripheral arterial disease: results from noninvasive testing in a defined population

Circulation

Occlusive Peripheral Artery Disease: Early diagnosis, incidence, course. significance

Mortality and morbidity in patients with intermittent claudication in relation to the location of the occlusive atheroscerosis in the leg

Angiology

Noninvasively diagnosed peripheral arterial disease as a predictor of mortality: results from a prospective study

Circulation

Recommendations for use of non-invasive methods to detect atherosclerotic peripheral arterial disease — In population studies

Circulation

The International Classification of Diseases

Marked decline of coronary heart disease mortality in 35–44 year-old white men in Allegheny County, Pennsylvania

Circulation

Statistical methods in epidemiology

Regression models and life tables (with discussion)

J. R. Stat. Soc.

Vital statistics of the United States

Research paper
The ratio of ankle and arm arterial pressure as an independent predictor of mortality