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Ankle-brachial index long-term outcome after first-ever ischaemic stroke


Correspondence: H. Milionis, Department of Inernal Medicince, School of Medicine, University of Ioannina, 45110 Ioannina, Greece (tel.: +302651007516; fax: +302651007016; e-mail:


Background and purpose

Ankle-brachial blood pressure index (ABI) is a clinical tool to identify the presence of peripheral artery disease. There is a scarcity of data associating ABI with long-term outcome in patients with IS. The association between ABI and long-term outcome in patients with first-ever acute IS was assessed.


Ankle-brachial blood pressure index was assessed in all consecutive patients with a first-ever acute IS admitted at Alexandra University hospital (Athens, Greece) between January 2005 and December 2010. ABI was considered normal when > 0.90 and ≤ 1.30. The Kaplan–Meier product limit method was used to estimate the probability of 5-year composite cardiovascular event-free (defined as recurrent stroke, myocardial infarction or cardiovascular death) and overall survival. A multivariate analysis was performed to assess whether ABI is an independent predictor of 5-year mortality and dependence.


Amongst 653 patients, 129 (19.8%) with ABI ≤ 0.9 were identified. Five-year cumulative composite cardiovascular event-free and overall survival rates were better in normal ABI stroke patients (log-rank test: 7.22, P = 0.007 and 23.40, P < 0.001, respectively). There was no difference in 5-year risk of stroke recurrence between low and normal ABI groups (hazard ratio, HR = 1.23, 95%CI 0.68–2.23). In multivariate Cox regression analysis, independent predictors of 5-year mortality included age (HR = 2.55 per 10 years, 95%CI 1.86–3.48, P < 0.001), the National Institutes of Health Stroke Scale (per point increase HR = 1.12, 95%CI 1.08–1.16, P < 0.001), and low ABI (HR = 2.22, 95%CI 1.22–4.03, P = 0.009). Age (HR = 1.21 per 10 years, 95%CI 1.01–1.45, P = 0.04) and low ABI (HR = 1.72, 95%CI 1.11–2.67, P = 0.01) were independent predictors of the composite cardiovascular end-point.


Low ABI in patients with acute IS is associated with increased 5-year cardiovascular event risk and mortality. However, ABI does not appear to predict long-term stroke recurrence.