THE ANKLE-BRACHIAL INDEX AS A PREDICTOR OF SURVIVAL IN PATIENTS WITH PERIPHERAL VASCULAR-DISEASE
THE ANKLE-BRACHIAL INDEX AS A PREDICTOR OF SURVIVAL IN PATIENTS WITH PERIPHERAL VASCULAR-DISEASE
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DOI：
10.1007/bf02599061
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发表时间：
1994-08-01
影响因子：
5.7
通讯作者：
PEARCE, WH
中科院分区：
文献类型：
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作者：
MCDERMOTT, MM;FEINGLASS, J;PEARCE, WH
目的：确定踝臂指数(ABI)是否能预测周围血管疾病患者的生存率。设计：对1987年访问作者的血流实验室的ABI异常患者的生存进行回顾性分析。使用全国死亡指数来确定截至1992年1月1日的所有患者的生存状况。使用Kaplan-Meier和Cox比例风险分析来确定ABI测量的下肢缺血增加与生存时间之间的关系。临床特征包括年龄、吸烟史、性别和合并症，以及是否存在下肢静息痛、溃疡或坏疽。地点：一所大学医院的血液流动实验室。患者/参与者：422名既往无下肢血管手术病史且患有AB的患者[S和lt；结果：随访52个月(4.3年)，ABI=0.5~0.91，ABI=0.31~0.49，ABI<0.3，累积生存概率分别为69%，62%，47%。在多变量Cox比例风险分析中，ABI值小于或等于0.3的患者与ABI值在0.5~0.91之间的患者相比，死亡的相对危险度是1.8(95%可信区间=1.2~2.9，p<；0.01)。其他独立预测预后较差的因素包括年龄65岁(p<；0.001)；癌症、肾功能衰竭或慢性肺病的诊断(p<；0.001)；充血性心力衰竭(p<；0.04)。ABI小于或等于0.3的患者的存活率明显低于ABI为0.31-0.91的患者。需要进一步的研究来确定积极的冠状动脉危险因素调整，对未诊断的冠状动脉或脑血管动脉粥样硬化疾病的检查，或对已知的动脉粥样硬化的积极治疗是否可以提高ABI小于或等于0.3的患者的生存率。
Objective: To determine whether the ankle-brachial index (ABI) predicts survival rates among patients with peripheral vascular disease.Design: A retrospective survival analysis of patients with abnormal ABIs who visited the authors' blood-flow laboratory during 1987. The National Death index was used to ascertain survival status for all patients up to January 1, 1992. Kaplan-Meier and Cox proportional hazards analyses were used to determine the relationship between increasing lower-extremity ischemia, measured by ABI, and survival time. Clinical characteristics controlled for included age, smoking history, gender, and comorbidities, as well as the presence of lower extremity rest pain, ulcer, or gangrene.Setting: A university hospital blood-flow laboratory.Patients/participants: Four hundred twenty-two patients who had no prior history of lower-extremity vascular procedures and who had AB[s < 0.92 in 1987.Results: Cumulative survival probabilities at 52 months' (4.3 years') follow-up were 69% for patients who had ABIs = 0.5-0.91, 62% for patients who had ABIs = 0.31-0.49, and 47% for patients who had ABIs less-than-or-equal-to 0.3. In multivariate Cox proportional hazard analysis, the relative hazard of death was 1.8 (95% confidence interval = 1.2-2.9, p < 0.01) for the patients who had ABIs less-than-or-equal-to 0.3 compared with the patients who had ABIs 0.5-0.91. Other independent predictors of poorer survival included age >65 years (p < 0.001); a diagnosis of cancer, renal failure, or chronic lung disease (p < 0.001); and congestive heart failure (p < 0.04).Conclusion: The ABI is a powerful tool for predicting survival in patients with peripheral vascular disease. Patients with ABIs less-than-or-equal-to 0.3 have significantly poorer survival than do patients with ABIs 0.31-0.91. Further study is needed to determine whether aggressive coronary risk-factor modification, a work-up for undiagnosed coronary or cerebrovascular atherosclerotic disease, or aggressive therapy for known atherosclerosis can improve survival of patients with ABIs less-than-or-equal-to 0.3.