AUTHOR=Berkovitch Anat , Iakobishvili Zaza , Fuchs Shmulik , Atar Shaul , Braver Omri , Eisen Alon , Glikson Michael , Beigel Roy , Matetzky Shlomi 

TITLE=Peripheral artery disease, abnormal ankle-brachial index, and prognosis in patients with acute coronary syndrome

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.902615

DOI=10.3389/fcvm.2022.902615

ISSN=2297-055X

ABSTRACT=Objectives: Ankle-brachial index (ABI) is an independent prognostic marker of cardiovascular events among patients with coronary artery disease.
We aimed to investigate the outcome of patients hospitalized with acute coronary syndrome (ACS) and abnormal ABI. 
Approach and Results: ABI was prospectively measured in 1,047 patients hospitalized due to ACS, who were stratified into three groups: those with clinical peripheral artery disease (PAD) (N=132), those without clinical PAD but with abnormal (<0.9) ABI (sub-clinical PAD; N=148) and those without clinical PAD with normal ABI (no PAD; N=767). Patients were prospectively followed for 30-day MACE (and 1-year all-cause mortality. Mean The mean age was 64 years. There was a significant gradual increase throughout the 3 groups in age, the incidence of prior stroke, diabetes mellitus, and hypertension (p for trend=0.001 for all). In-hospital course showed a gradual rise in the incidence of complications with an increase in heart failure [2.5%, 6.1%, and 9.2% (p for trend=0.001)], and acute kidney injury [2%, 4.1% and 11.5%, (p for trend=0.001)]. At day 30 there was a stepwise increase in MACE, such that non-PAD patients had the lowest rate, followed by sub-clinical and clinical PAD (3.5%, 6.8%, 8.1%, respectively, p for trend=0.009). Likewise, there was a significant increase in 1-year mortality from 3.4% in non-PAD patients, through 6.8% in sub-clinical PAD, to 15.2% in clinical PAD (p for trend=0.001). 
Conclusions: Sub-clinical PAD is associated with poor outcomes in ACS patients, suggesting that routine ABI screening could carry important prognostic significance in these patients regardless of PAD symptoms.