Association between Low Ankle-Brachial Index and Poor Outcomes in Patients with Embolic Stroke of Undetermined Source
We investigated the association of low ankle-brachial index (ABI < 0.9) with major adverse cardiovascular events (MACE) and all-cause mortality in patients with embolic stroke of undetermined source (ESUS) as well as whether the association differed by ESUS subtype. This retrospective single-cent...
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MDPI AG
2022-05-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/11/3073 |
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| author | Minho Han JoonNyung Heo Jae Wook Jung Il Hyung Lee Joon Ho Kim Hyungwoo Lee Young Dae Kim Hyo Suk Nam |
| author_facet | Minho Han JoonNyung Heo Jae Wook Jung Il Hyung Lee Joon Ho Kim Hyungwoo Lee Young Dae Kim Hyo Suk Nam |
| author_sort | Minho Han |
| collection | DOAJ |
| description | We investigated the association of low ankle-brachial index (ABI < 0.9) with major adverse cardiovascular events (MACE) and all-cause mortality in patients with embolic stroke of undetermined source (ESUS) as well as whether the association differed by ESUS subtype. This retrospective single-center study included ESUS patients who underwent transesophageal echocardiography and ABI during hospitalization. ESUS was classified as ESUS with minor cardioembolic source, arteriogenic embolism, two or more causes, or no cause. Arteriogenic embolism was defined and classified as complex aortic or non-stenotic relevant artery plaque. MACE was defined as stroke recurrence, acute coronary syndrome, hospitalization for heart failure, or death. Overall, 829 patients were included, with a median follow-up of 45.8 months. Of these, 42 (5.1%) and 370 (44.6%) had low ABI and arteriogenic embolism, respectively. ABI < 0.9 was independently associated with MACE (hazard ratio [HR]: 2.038, 95% confidence interval [CI]: 1.093–3.801) and all-cause mortality (HR: 3.608, 95% CI: 1.538–8.465) according to the multivariable Cox regression analysis. Between ESUS subtypes, low ABI was independently associated with MACE (HR: 2.513, 95% CI: 1.257–5.023) and all-cause mortality (HR: 5.681, 95% CI: 2.151–15.008) in arteriogenic embolism patients, especially in those with complex aortic plaque. However, in non-arteriogenic embolism patients, low ABI was not related to MACE and mortality. In ESUS patients, low ABI was linked to MACE and all-cause mortality, especially in those with arteriogenic embolisms from complex aortic plaque. |
| first_indexed | 2024-03-10T01:11:56Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T01:11:56Z |
| publishDate | 2022-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-1ea4f4515eed4399b4e2955cd11855e02023-11-23T14:16:22ZengMDPI AGJournal of Clinical Medicine2077-03832022-05-011111307310.3390/jcm11113073Association between Low Ankle-Brachial Index and Poor Outcomes in Patients with Embolic Stroke of Undetermined SourceMinho Han0JoonNyung Heo1Jae Wook Jung2Il Hyung Lee3Joon Ho Kim4Hyungwoo Lee5Young Dae Kim6Hyo Suk Nam7Department of Neurology, Yonsei University College of Medicine, Seoul 03722, KoreaDepartment of Neurology, Yonsei University College of Medicine, Seoul 03722, KoreaDepartment of Neurology, Yonsei University College of Medicine, Seoul 03722, KoreaDepartment of Neurology, Yonsei University College of Medicine, Seoul 03722, KoreaDepartment of Neurology, Yonsei University College of Medicine, Seoul 03722, KoreaDepartment of Neurology, Yonsei University College of Medicine, Seoul 03722, KoreaDepartment of Neurology, Yonsei University College of Medicine, Seoul 03722, KoreaDepartment of Neurology, Yonsei University College of Medicine, Seoul 03722, KoreaWe investigated the association of low ankle-brachial index (ABI < 0.9) with major adverse cardiovascular events (MACE) and all-cause mortality in patients with embolic stroke of undetermined source (ESUS) as well as whether the association differed by ESUS subtype. This retrospective single-center study included ESUS patients who underwent transesophageal echocardiography and ABI during hospitalization. ESUS was classified as ESUS with minor cardioembolic source, arteriogenic embolism, two or more causes, or no cause. Arteriogenic embolism was defined and classified as complex aortic or non-stenotic relevant artery plaque. MACE was defined as stroke recurrence, acute coronary syndrome, hospitalization for heart failure, or death. Overall, 829 patients were included, with a median follow-up of 45.8 months. Of these, 42 (5.1%) and 370 (44.6%) had low ABI and arteriogenic embolism, respectively. ABI < 0.9 was independently associated with MACE (hazard ratio [HR]: 2.038, 95% confidence interval [CI]: 1.093–3.801) and all-cause mortality (HR: 3.608, 95% CI: 1.538–8.465) according to the multivariable Cox regression analysis. Between ESUS subtypes, low ABI was independently associated with MACE (HR: 2.513, 95% CI: 1.257–5.023) and all-cause mortality (HR: 5.681, 95% CI: 2.151–15.008) in arteriogenic embolism patients, especially in those with complex aortic plaque. However, in non-arteriogenic embolism patients, low ABI was not related to MACE and mortality. In ESUS patients, low ABI was linked to MACE and all-cause mortality, especially in those with arteriogenic embolisms from complex aortic plaque.https://www.mdpi.com/2077-0383/11/11/3073ankle-brachial indexembolismprognosisstroke |
| spellingShingle | Minho Han JoonNyung Heo Jae Wook Jung Il Hyung Lee Joon Ho Kim Hyungwoo Lee Young Dae Kim Hyo Suk Nam Association between Low Ankle-Brachial Index and Poor Outcomes in Patients with Embolic Stroke of Undetermined Source Journal of Clinical Medicine ankle-brachial index embolism prognosis stroke |
| title | Association between Low Ankle-Brachial Index and Poor Outcomes in Patients with Embolic Stroke of Undetermined Source |
| title_full | Association between Low Ankle-Brachial Index and Poor Outcomes in Patients with Embolic Stroke of Undetermined Source |
| title_fullStr | Association between Low Ankle-Brachial Index and Poor Outcomes in Patients with Embolic Stroke of Undetermined Source |
| title_full_unstemmed | Association between Low Ankle-Brachial Index and Poor Outcomes in Patients with Embolic Stroke of Undetermined Source |
| title_short | Association between Low Ankle-Brachial Index and Poor Outcomes in Patients with Embolic Stroke of Undetermined Source |
| title_sort | association between low ankle brachial index and poor outcomes in patients with embolic stroke of undetermined source |
| topic | ankle-brachial index embolism prognosis stroke |
| url | https://www.mdpi.com/2077-0383/11/11/3073 |
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