Ankle-Brachial Index and cardiovascular events in atrial fibrillation

Francesco Violi; Giovanni Davi; Marco Proietti; Daniele Pastori; William R. Hiatt; Gino Roberto Corazza; Francesco Perticone; Pasquale Pignatelli; Alessio Farcomeni; Anna Rita Vestri; Gregory Y. H. Lip; Stefania Basili; The ARAPACIS (Atrial Fibrillation Registry for Ankle-Brachial Index Prevalence Assessment-Collaborative Italian Study) STUDY Investigators; on Behalf of

doi:10.1160/TH15-07-0612

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2016; 115(04): 856-863
DOI: 10.1160/TH15-07-0612

Atherosclerosis and Ischaemic Disease

Schattauer GmbH

Ankle-Brachial Index and cardiovascular events in atrial fibrillation

The ARAPACIS Study

Francesco Violi

¹I Clinica Medica, Sapienza-University of Rome, Rome, Italy

,

Giovanni Davi

²Internal Medicine, University Of Chieti, Chieti, Italy

,

Marco Proietti

³University of Birmingham, Institute of Cardiovascular Sciences, Birmingham, UK

,

Daniele Pastori

¹I Clinica Medica, Sapienza-University of Rome, Rome, Italy

,

William R. Hiatt

⁴University of Colorado School Of Medicine, Division of Cardiology, Aurora, Colorado, USA

,

Gino Roberto Corazza

⁵First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy

,

Francesco Perticone

⁶Deparment of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy

,

Pasquale Pignatelli

¹I Clinica Medica, Sapienza-University of Rome, Rome, Italy

,

Alessio Farcomeni

⁷Department of Public Health and Infectious Disease, Sapienza-University of Rome, Rome, Italy

,

Anna Rita Vestri

⁷Department of Public Health and Infectious Disease, Sapienza-University of Rome, Rome, Italy

,

Gregory Y. H. Lip

³University of Birmingham, Institute of Cardiovascular Sciences, Birmingham, UK

⁸Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

,

Stefania Basili

¹I Clinica Medica, Sapienza-University of Rome, Rome, Italy

,

The ARAPACIS (Atrial Fibrillation Registry for Ankle-Brachial Index Prevalence Assessment-Collaborative Italian Study) STUDY Investigators

› Author Affiliations

Abstract

Summary

Atrial fibrillation (AF) patients are at high risk for thrombotic and vascular events related to their cardiac arrhythmia and underlying systemic atherosclerosis. Ankle-Brachial Index (ABI) is a non-invasive tool in evaluating systemic atherosclerosis, useful in predicting cardiovascular events in general population; no data are available in AF patients. ARAPACIS is a prospective multicentre observational study performed by the Italian Society of Internal Medicine, analysing association between low ABI (≤0.90) and vascular events in NVAF out- or in-patients, enrolled in 136 Italian centres. A total of 2,027 non-valvular AF (NVAF) patients aged > 18 years from both sexes followed for a median time of 34.7 (interquartile range: 22.0–36.0) months, yielding a total of 4,614 patient-years of observation. Mean age was 73 ± 10 years old with 55% male patients. A total of 176 patients (8.7%) experienced a vascular event, with a cumulative incidence of 3.81%/patient-year. ABI≤ 0.90 was more prevalent in patients with a vascular event compared with patients free of vascular events (32.2 vs 20.2%, p< 0.05). On Cox proportional hazard analysis, ABI≤ 0.90 was an independent predictor of vascular events (hazard ratio (HR): 1.394, 95% confidence interval (CI): 1.042–1.866; p=0.02), vascular death (HR: 2.047, 95% CI: 1.255-3.338; p=0.004) and MI (HR: 2.709, 95%> CI: 1.485-5.083; p=0.001). This latter association was also confirmed after excluding patients with previous MI (HR: 2.901, 95% CI: 1.408-5.990, p=0.004). No association was observed between low ABI and stroke/transient ischaemic attack (p=0.91). In conclusion, low ABI is useful to predict MI and vascular death in NVAF patients and may independently facilitate cardiovascular risk assessment in NVAF patients.

Note: The review process for this paper was fully handled by C. Weber, Editor in Chief.

Listed in the Supplementary Online Appendix Material which is available online at www.thrombosis-online.com.

Keywords

Atrial fibrillation - ABI - ARAPACIS - myocardial infarction - vascular events

Full Text

References

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