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Peripheral Arterial Occlusive Disease: Prognostic Value of Signs, Symptoms, and the Ankle-Brachial Pressure Index

Department of General Practice, Research Institute for Extramural and Transmural Health Care, Maastricht University, Maastricht, The Netherlands

Henri E.J.H. Stoffers, MD, PhD

Department of General Practice, Research Institute for Extramural and Transmural Health Care, Maastricht University, Maastricht, The Netherlands

Arnold D. M. Kester, PhD

Department of Methodology and Statistics, Research Institute for Extramural and Transmural Health Care, Maastricht University, Maastricht, The Netherlands

Jan W. van Ree

Department of General Practice, Research Institute for Extramural and Transmural Health Care, Maastricht University, Maastricht, The Netherlands

J. André Knottnerus

Department of General Practice, Research Institute for Extramural and Transmural Health Care, Maastricht University, Maastricht, The Netherlands

Objectives. To determine whether different levels of the ankle-brachial pressure index (ABPI) are associated with an increased risk for progressive limbischemia, nonfatal and fatal cardiovascular events. To investigate the prognostic value of signs and symptoms associated with peripheral arterial occlusive disease (PAOD). Design. Prospective follow-up study.Setting. Eighteen general practice centers in the Netherlands.Participants. Three thousand six hundred forty-nine participants (53% female) with a mean age of 59 years (range: 40-78 years). Main outcome measures. Progressive limbischemia, cardiovascular morbidity and mortality. Results. At baseline, 458 participants had PAOD, defined as an ABPI < 0.95. Among these, 148 (32.2%) had an ABPI < 0.70. Cox proportional hazards models showed that after a mean follow-up period of 7.2 years, PAOD patients with an ABPI < 0.70 were at higher risk for cardiovascular death, compared with participants with a moderately reduced ABPI (< 0.95 - 0.70): HR 2.3 versus 1.2. Older age, complaints of intermittent claudication, abnormal pedal pulses, elevated blood pressure, and coexisting cardiovascular disease at baseline were also significant independent prognostic factors for one or more of the adverse outcome events in these patients. Conclusion. The ABPI is inversely associated with cardiovascular mortality in PAOD patients. A low ABPI is an independent predictor for cardiovascular mortality in PAOD patients.

Key Words: peripheral vascular disease • intermittent claudication • prognostic determinants • ankle brachial pressure index • cardiovascular disease

Medical Decision Making, Vol. 22, No. 2, 99-107 (2002)
DOI: 10.1177/0272989X0202200208


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