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Prevalence of Peripheral Artery Disease by Abnormal Ankle-Brachial Index in Atrial Fibrillation: Implications for Risk and Therapy.

By Violi F., Davì G., Hiatt W., Lip G.Y.H., Corazza G.R., Perticone F., Proietti M., Pignatelli P., Vestri A.R., Basili S., ARAPACIS Study Investigators, Fabbian F. and Manfredini R.


Nonvalvular atrial fibrillation (NVAF) is associated with a 5-fold increased risk for stroke. Moreover, patients with NVAF often suffer from atherosclerotic complications such as acute myocardial infarction (AMI). Peripheral artery disease (PAD) is an established marker of systemic atherosclerosis but its prevalence in NVAF is still unclear. We reasoned that inclusion of ankle-brachial index (ABI), which is an established tool for diagnosis of PAD, in the CHA2DS2-VASc score would better define the prevalence of vascular disease. The Atrial Fibrillation Registry for the ARAPACIS (Ankle-brachial Index Prevalence Assessment: Collaborative Italian Study) study is an independent research project involving all Regional Councils of SIMI. The first objective of the study was to estimate the prevalence of ABI ≤0.90 in NVAF patients. Among the 2,027 NVAF patients included in the study, hypertension was detected in 83%, diabetes mellitus in 23%, dyslipidemia in 39%, metabolic syndrome in 29%, and smoking in 15%. At least 1 atherosclerotic risk factor was detected in 90% of patients.The NVAF population was at high risk for stroke, with only 18% having a CHA2DS2-VASc score of 0 to 1, while 82% had a risk ≥2. Among the AF population, 428 patients (21%) had ABI ≤0.90 compared with 1,381 patients, who had an ABI of 0.91 to 1.39 (69%); 204 patients (10%) had ABI ≥1.40. ABI recorded only in 1 leg was excluded from the analysis (n = 14). ABI ≤0.90 progressively increased from paroxysmal to permanent NVAF (18%, 21%, 24%; p = 0.0315). ABI ≤0.90 was significantly associated with a smoking habit (OR: 1.99; 1.48-2.66; p<0.0001), diabetes OR: 1.93; 1.51-2.46; p<0.0001), age class 65 to 74 years (OR: 2.05; 1.40-3.07; p<0.0001), age class ≥75 years (OR: 3.12; 2.16-4.61; p<0.0001), and history of previous transient ischemic attack/stroke (OR: 1.64; 1.20-2.24; p=0.002). Vascular disease, as assessed by the history elements of CHA2DS2VASc score, was recorded in 17.3% of patients; inclusion of ABI ≤0.90 in the definition of vascular disease yielded a total prevalence of 33%. A higher prevalence of vascular disease was detected if ABI ≤0.90 was included in the CHA2DS2VASc score. CHA2DS2VASc including ABI ≤0.90 was more associated with previous stroke (43%; OR: 1.85; 1.41-2.44; p<0.0001) compared to CHA2DS2VASc with ABI 0.91 to 1.39 (23%; OR: 1.52; 1.10-2.11; p=0.0117).This is the first evidence that one-fifth of NVAF patients had an ABI ≤0.90, indicating that it may represent a simple and cheap method to better define the prevalence of vascular disease in NVAF

Topics: Atrial fibrillation, cardiovascular disease, Peripheral vascular disease
Year: 2013
DOI identifier: 10.1016/j.jacc.2013.07.035
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