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      Predictive value of the ankle brachial index in patients with acute ischemic stroke

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          Abstract

          Background: Peripheral arterial disease (PAD) is frequently present in patients with acute ischemic stroke. However, there are limited data regarding the association between ankle brachial index (ABI) ≤ 0.90 (which is diagnostic of PAD) or > 1.40 (suggesting calcified arteries) and the severity of stroke and in-hospital outcome in this population. We aimed to evaluate these associations in patients with acute ischemic stroke. Patients and methods: We prospectively studied 342 consecutive patients admitted for acute ischemic stroke (37.4 % males, mean age 78.8 ± 6.4 years). The severity of stroke was assessed with the National Institutes of Health Stroke Scale (NIHSS)and the modified Rankin scale (mRS) at admission. The outcome was assessed with the mRS and dependency (mRS 2 - 5) at discharge and in-hospital mortality. Results: An ABI ≤ 0.90 was present in 24.6 % of the patients whereas 68.1 % had ABI 0.91 - 1.40 and 7.3 % had ABI > 1.40. At admission, the NIHSS score did not differ between the 3 groups (10.4 ± 10.6, 8.3 ± 9.3 and 9.3 ± 9.4, respectively). The mRS score was also comparable in the 3 groups (3.6 ± 1.7, 3.1 ± 1.8 and 3.5 ± 2.3, respectively). At discharge, the mRS score did not differ between the 3 groups (2.9 ± 2.2, 2.3 ± 2.1 and 2.7 ± 2.5, respectively) and dependency rates were also comparable (59.5, 47.6 and 53.3 %, respectively). In-hospital mortality was almost two-times higher in patients with ABI ≤ 0.90 than in patients with ABI 0.91 - 1.40 or > 1.40 but this difference was not significant (10.9, 6.6 and 6.3 %, respectively). Conclusions: An ABI ≤ 0.90 or > 1.40 does not appear to be associated with more severe stroke or worse in-hospital outcome in patients with acute ischemic stroke.

          Abstract

          Hintergrund: Die periphere arterielle Verschlusskrankheit (pAVK) ist häufig bei Patienten mit akutem Schlaganfall vorhanden. Jedoch gibt es nur wenig Erkentnisse bezüglich der Assoziation zwischen einem Knöchel-Arm-Index (ABI) von ≤ 0.9 (der zur Diagnose der pAVK führt) oder von > 1.4 (der verkalkte Arterien vermuten lässt) und der Schwere des Schlaganfalles und des Ausganges der Erkrankung. Ziel unserer Arbeit ist die Evaluation dieser vermutlichen Assoziationen bei Schlaganfallpatienten. Patienten und Methoden: Wir untersuchten 342 konsekutive Patienten mit akutem Schlaganfall prospektiv (37.4 % Männer, Durchschnittsalter 78.8 ± 6.4 Jahre). Die Schwere des Schlaganfalles wurde mit dem National Institutes of Health Stroke Scale (NIHSS) und dem modifizierten Rankin Scale (mRS) bei der Aufnahme der Patienten gemessen. Der Ausgang der Erkrankung wurde anhang des mRS Wertes bei der Entlassung und der Krankenhausmortalität festgestellt. Ergebnisse: 24.6 % der Patienten hatten einen ABI von ≤ 0.9, 68.1 % von 0.91 - 1.40 und 7.3 % über 1.4. Bei Aufnahme wurden keine Unterschiede bezüglich des NIHSS (jeweils 10.4 ± 10.6, 8.3 ± 9.3 und 9.3 ± 9.4) als auch des mRS Wertes (3.6 ± 1.7, 3.1 ± 1.8 und 3.5 ± 2.3 jeweils) der Patienten dieser drei Gruppen festgestellt. Bei der Entlassung konnten keine Unterschiede bezüglich des mRS Wertes zwischen den drei Gruppen festgestellt werden (jeweils 2.9 ± 2.2, 2.3 ± 2.1 und 2.7 ± 2.5). Die Krankenhausmortalität war fast doppelt so hoch bei Patienten mit einem ABI von ≤ 0.90 im Vergleich zu Patienten mit einem Wert zwischen 0.91 - 1.40 oder über > 1.40, aber dieses Ergebniss war statistisch nicht signifikant (10.9, 6.6 und 6.3 % jeweils). Schlussfolgerungen: Ein ABI ≤ 0.90 oder > 1.40 scheint nicht in Verbindung zu einem schwereren Schlaganfall oder einem schlechteren Ausgang des Schlaganfalles zu stehen.

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          Author and article information

          Affiliations
          [ 1 ] First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
          [ 2 ] First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
          [ 3 ] First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
          [ 4 ] First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
          [ 5 ] First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
          [ 6 ] First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
          [ 7 ] First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
          [ 8 ] First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
          [ 9 ] First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
          [ 10 ] First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
          Journal
          vas
          122285
          Vasa
          European Journal of Vascular Medicine
          Hogrefe AG, Bern
          0301-1526
          1664-2872
          1 January 2014
          15 January 2014
          : 43
          : 1 ( otherID: Q3775W75263X )
          : 55-61
          10.1024/0301-1526/a000328 W8Q7W205819X7677
          Product
          Self URI (journal page): https://econtent.hogrefe.com/loi/vas
          Categories
          Original communication

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