The prognosis of diabetic patients with high ankle-brachial index depends on the coexistence of occlusive peripheral artery disease
The prognosis of diabetic patients with high ankle-brachial index depends on the coexistence of occlusive peripheral artery disease
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DOI：
10.1016/j.jvs.2010.10.054
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发表时间：
2011-04-01
影响因子：
4.3
通讯作者：
Laskar, Marc
中科院分区：
文献类型：
--
作者：
Aboyans, Victor;Lacroix, Philippe;Laskar, Marc
目的：高踝臂指数（ABI）（> 1.40）与心血管疾病（CVD）预后不良相关。伴随的外周动脉疾病（PAD）是常见的，尽管在这种情况下ABI检测不到。我们评估了高ABI的预后价值，根据共存的闭塞性PAD在diabetes.Methods：在这项回顾性纵向研究中，我们回顾了403例连续糖尿病患者（在三级护理教学医院住院）的数据，他们的下肢在1999年和2000年之间的多普勒评估。当Doppler波形模式（DWP）正常且ABI在0.91~1.39范围内时，将其归类为"正常"，当ABI = 1.40且DWP正常时，将其归类为"闭塞性PAD（O-PAD）"，当ABI>= 1.40且DWP异常时，将其归类为"混合性疾病（MD）"。结果：患者年龄65.6 ± 13.2岁，女性54.6%，分为正常组（14.4%）、O-PAD组（48.4%）、IMC组（16.4%）和MD组（20.8%）。在平均6.5年的随访中，O-PAD和MD组的无事件生存曲线显示出同样比IMC和正常组更差的预后。根据年龄、性别、糖尿病类型和持续时间、传统CVD风险因素、慢性肾脏疾病、CVD病史和治疗、闭塞性疾病的存在进行校正（风险比[HR]：2.21，1.16 - 4.22，P = 0.016），而不是中膜钙质沉着，与主要结果显著相关。在ABI> 1.40的糖尿病患者中，只有合并PAD闭塞的患者预后较差。（J Vasc Surg 2011; 53：984 - 91.）
Objectives: High ankle-brachial index (ABI) (>1.40) is associated with poor cardiovascular disease (CVD) prognosis. Concomittant peripheral artery disease (PAD) is frequent, although undetectable with the ABI in this situation. We assessed the prognostic value of a high ABI according to the coexistence of occlusive PAD in diabetics.Methods: In this retrospective longitudinal study, we reviewed the data of 403 consecutive diabetic patients (hospitalized in tertiary care teaching hospital) who had a Doppler assessment of their lower limbs between 1999 and 2000. They were classified as "normal" when Doppler waveform patterns (DWP) were normal and ABI within the 0.91 to 1.39 range, "occlusive-PAD (O-PAD)" when ABI = 1.40 with normal DWP, and "mixed disease (MD)" when ABI >= 1.40 with abnormal DWP. The primary outcome was the occurrence of any of the following events: death, stroke or transient ischemic attack (TIA), and acute coronary syndrome.Results: The patients (65.6 +/- 13.2 years, 54.6% females) were classified as normal (14.4%), O-PAD (48.4%), IMC (16.4%), and MD (20.8%). During a mean follow-up of 6.5 years, the event-free survival curves of O-PAD and MD groups showed equally poorer prognosis than the IMC and normal groups. Adjusted for age, sex, diabetes type and duration, traditional CVD risk factors, chronic kidney disease, CVD history and treatments, the presence of occlusive disease (hazard ratio [HR]: 2.21, 1.16-4.22, P = .016), but not medial calcinosis, was significantly associated with the primary outcome.Conclusions: In diabetics with ABI >1.40, only those with concommittant occlusive PAD have poorer prognosis. (J Vasc Surg 2011;53:984-91.)