Predictive value of ankle brachial index in patients with acute ischaemic stroke


F. Purroy, Stroke Unit, Departamento de Neurología, Hospital Universitari Arnau de Vilanova de Lleida, Universitat de Lleida, Biomedical Research Institute of Lleida, IRBLLEIDA, Lleida, Spain; Avda Rovira Roure, 80 Lleida, 25198, Spain (tel.: +34 973 248100; fax: +34 973 248754; e-mail:


Background:  The ankle brachial index (ABI) is a known measure of lower-limb peripheral artery disease (PAD), as well as a marker for other cardiovascular disease events.

Objective:  Our goal was to compare the prevalence of abnormal ABI scores (ABI ≤ 0.9) between: consecutive patients with acute ischaemic stroke (IS), primary care patients with refractory hypertension (rHT), and patients at intermediate cardiovascular risk (ICVR). Also, to determine the prognostic value of abnormal ABI for stroke recurrence in patients with IS.

Methods:  We compared 116 consecutive patients with IS with 190 rHT and 150 ICVR patients. Clinical data and ultrasonographic findings were recorded. Stroke recurrence and risk of new vascular events were assessed after 18 months of follow-up.

Results:  Low ABI was more frequent in rHT (35.8%) than in the IS (24.1%) and ICVR (24.7%) groups (P = 0.031). Amongst patients with IS, ABI ≤ 0.9 was associated with vascular risk factors (VRF) ≥3 (33.8% vs. 7.1%, P = 0.001) and large-artery atherosclerosis (LAA) (43.5% vs. 19.4%, P = 0.015). Multivariate analyses (logistic regression) only identified VRF > 3 as independently associated with low ABI (OR: 6.46; 1.81-23.02; P = 0.004). Abnormal ABI was associated with stroke recurrence (32.1% vs. 13.6%, P = 0.027) and the appearance of any major vascular event (50.0% vs. 17.0%, P < 0.001). In the logistic regression analysis, adjusted for VRF, age, and LAA, ABI remained as an independent predictor of vascular events (HR 3.99; 1.90–8.41 P < 0.001).

Conclusion:  Abnormal ABI was associated with classical risk factors, especially hypertension. The measurement of ABI amongst patients with IS appeared to be useful to identify high-risk patients and plan adequate prevention therapies.