Toe pressure and toe brachial index are predictive of cardiovascular mortality regardless of the most diseased arterial segment in symptomatic lower-extremity artery disease-A retrospective cohort study

V Koivunen; M Juonala; M Venermo; M Laivuori; J M Jalkanen; H H Hakovirta

doi:10.1371/journal.pone.0259122

Toe pressure and toe brachial index are predictive of cardiovascular mortality regardless of the most diseased arterial segment in symptomatic lower-extremity artery disease-A retrospective cohort study

PLoS One. 2021 Nov 15;16(11):e0259122. doi: 10.1371/journal.pone.0259122. eCollection 2021.

Authors

V Koivunen¹, M Juonala^{1

2

3}, M Venermo⁴, M Laivuori⁴, J M Jalkanen^{1

5}, H H Hakovirta^{1

5

6}

Affiliations

¹ Faculty of Medicine, University of Turku, Turku, Finland.
² Department of Internal Medicine, University of Turku, Turku, Finland.
³ Division of Medicine, Turku University Hospital, Turku, Finland.
⁴ Department of Vascular Surgery, Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
⁵ Department of Vascular Surgery, Turku University Hospital, University of Turku, Turku, Finland.
⁶ Department of Surgery, Satakunta Central Hospital, Pori, Finland.

Abstract

Objective: Although lower extremity arterial disease (LEAD) is most often multisegmental, the predominant disease location and risk factors differ between patients. Ankle-brachial index (ABI), toe-brachial index (TBI), and toe pressure (TP) are predictive of outcome in LEAD patients. Previously, we reported a classification method defining the most diseased arterial segment (MDAS); crural (CR), femoropopliteal (FP), or aortoiliac (AOI). Current study aimed to analyze the associations between MDAS, peripheral pressure measurements and cardiovascular mortality.

Materials and methods: We reviewed retrospectively 729 consecutive LEAD patients (Rutherford 2-6) who underwent digital subtraction angiography between January, 2009 to August, 2011 and had standardized peripheral pressure measurements.

Results: In Cox Regression analyses, cardiovascular mortality was associated with MDAS and non-invasive pressure indices as follows; MDAS AOI, TP <30 mmHg (HR 3.00, 95% CI 1.13-7.99); MDAS FP, TP <30 mmHg (HR 2.31, 95% CI 1.36-3.94), TBI <0.25 (HR 3.20, 95% CI 1.34-7.63), ABI <0.25 (HR 5.45, 95% CI 1.56-19.0) and ≥1.30 (HR 6.71, 95% CI 1.89-23.8), and MDAS CR, TP <30 mmHg (HR 4.26, 95% CI 2.19-8.27), TBI <0.25 (HR 7.71, 95% CI 1.86-32.9), and ABI <0.25 (HR 2.59, 95% CI 1.15-5.85).

Conclusions: Symptomatic LEAD appears to be multisegmental with severe infrapopliteal involvement. Because of this, TP and TBI are strongly predictive of cardiovascular mortality and they should be routinely measured despite the predominant disease location or clinical presentation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Ankle Brachial Index
Humans
Middle Aged
Peripheral Arterial Disease*

Grants and funding

Authors M.J. and H.H.H were funded by federal research grants from Turku University Hospital. The funder (Turku University Hospital) had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.