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Low ankle−brachial index predicts new vascular events and functional outcome after 1 year in patients with non-cardioembolic stroke: our experience and review

Authors

  • J. Alvarez-Sabín,

    Corresponding author
    1. Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Hospital Vall d'Hebron, Barcelona, Spain
    • Correspondence: J. Alvarez-Sabín, Department of Neurology, Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035 Barcelona, Spain (tel.: (+34)934894257; fax: (+34)934894257;e-mail: josalvarez@vhebron.net).

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  • M. Quintana,

    1. Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Hospital Vall d'Hebron, Barcelona, Spain
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  • E. Santamarina,

    1. Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Hospital Vall d'Hebron, Barcelona, Spain
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  • O. Maisterra,

    1. Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Hospital Vall d'Hebron, Barcelona, Spain
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  • A. Gil-Núñez

    1. Stroke Unit, Department of Neurology, Hospital Universitario Gregorio Marañon, Universidad Complutense, Madrid, Spain
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Abstract

Background and purpose

The ankle−brachial index (ABI) has been defined as an important factor associated with vascular events. Our objective was to analyze the prognostic value of the ABI as a predictive factor of new vascular events and functional status at 1 year in patients with non-cardioembolic ischaemic stroke.

Methods

A prospective, longitudinal, observational and multicenter study was performed, including consecutive patients ≥50 years old who had suffered from a non-cardioembolic ischaemic stroke. Pathological ABI (PI) was defined when the value was ≤0.9. The logistic regression model, survival analysis and the Cox proportional hazard regression model were used to identify factors independently associated with functional outcome and occurrence of new vascular events, including recurrent stroke.

Results

In all, 977 patients were evaluated. The mean age was 69.1 ± 9.5 years. 40.5% patients had PI. Stroke recurrence and new vascular events global rates were 9% and 20% respectively at 1 year. PI was independently associated with new vascular events [hazard ratio 1.764 (1.274–2.444), P = 0.001]. A cut-off point of ABI ≤ 0.8 (14% vs. 7%, P = 0.002) independently predicted stroke recurrence in an adjusted regression model [hazard ratio 1.807 (1.102–2.963), P = 0.019]. PI was also associated with functional dependence [odds ratio 1.490 (1.011–2.196), P = 0.044].

Conclusions

In non-cardioembolic ischaemic stroke patients, PI was an independent predictive factor of new vascular events and functional outcome after 1 year of follow-up.

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