European Heart Journal Advance Access originally published online on July 4, 2006
European Heart Journal 2006 27(15):1861-1867; doi:10.1093/eurheartj/ehl114
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Ankle-brachial index and extent of atherothrombosis in 8891 patients with or at risk of vascular disease: results of the international AGATHA study
1 Department of Public Health Sciences, Wolfson Unit for the Prevention of Peripheral Vascular Diseases, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK
2 Low Cardiology Clinic, Singapore, Singapore
3 Institute of Cerebrovascular Diseases, Bucharest, Romania
4 University of Toronto, Toronto, Canada
Received 21 June 2005; revised 17 May 2006; accepted 8 June 2006; online publish-ahead-of-print 4 July 2006.
* Corresponding author. Tel: +44 131 650 3220; fax: +44 131 650 6904. E-mail address: gerry.fowkes{at}ed.ac.uk
Aims AGATHA (a Global Atherothrombosis Assessment) was designed to assess the extent of atherothrombosis and the use of the ankle-brachial index (ABI) in vascular patients. The principal hypotheses were that (1) in diseased patients, a low ABI was related to the number and site of vascular beds affected and (2) in at-risk patients without disease, a low ABI was related to the number of risk factors present.
Methods and results Patients were recruited consecutively by 482 clinicians in 24 countries and the ABI measurement was performed at a single visit. Of 8891 patients recruited, 1792 were defined as at risk and 7099 as with disease. Of the with-disease patients, 65.2% had one arterial bed affected, 27.6% two and 7.1% all three. Abnormal ABI (
0.9) was present in 30.9% of at-risk and 40.5% of with-disease patients. A lower ABI was weakly associated with an increasing number of risk factors in at-risk patients (r=–0.056, P=0.02) and with the site and number of arterial beds affected in with-disease patients (P<0.001).
Conclusion This large international study confirms that atherothrombotic disease often occurs at more than one site. The ABI is related to the risk factor profile and to the site and extent of atherothrombosis.
Key Words: Ankle-brachial index • Atherothrombosis • Myocardial infarction • Peripheral arterial disease • Stroke • Patients at risk
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