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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
1   I Clinica Medica, Sapienza-University of Rome, Rome, Italy
,
Giovanni Davi
2   Internal Medicine, University Of Chieti, Chieti, Italy
,
Marco Proietti
3   University of Birmingham, Institute of Cardiovascular Sciences, Birmingham, UK
,
Daniele Pastori
1   I Clinica Medica, Sapienza-University of Rome, Rome, Italy
,
William R. Hiatt
4   University of Colorado School Of Medicine, Division of Cardiology, Aurora, Colorado, USA
,
Gino Roberto Corazza
5   First Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
,
Francesco Perticone
6   Deparment of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
,
Pasquale Pignatelli
1   I Clinica Medica, Sapienza-University of Rome, Rome, Italy
,
Alessio Farcomeni
7   Department of Public Health and Infectious Disease, Sapienza-University of Rome, Rome, Italy
,
Anna Rita Vestri
7   Department of Public Health and Infectious Disease, Sapienza-University of Rome, Rome, Italy
,
Gregory Y. H. Lip
3   University of Birmingham, Institute of Cardiovascular Sciences, Birmingham, UK
8   Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
,
Stefania Basili
1   I 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
Further Information

Publication History

Received: 31 July 2015

Accepted after major revision: 13 January 2015

Publication Date:
29 November 2017 (online)

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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

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