Perioperative cardiovascular evaluation: heads or tails?

The Ankle-Brachial Index is Associated With Cardiovascular Complications After Noncardiac Surgery

Background:

This study evaluated the association of the ankle-brachial index (ABI) and cardiovascular complications after noncardiac surgery.

Methods:

We prospectively evaluated patients referred for noncardiac surgery. The ABI was performed before surgery. Patients with abnormal ABI (≤0.9) were included in the peripheral artery disease (PAD) group and the remaining constituted the control group. Cardiac troponin and electrocardiogram were obtained 72 hours after surgery. Patients were followed up to 30 days, and primary end point was the occurrence of any cardiovascular event: cardiovascular death, acute coronary syndrome, isolated troponin elevation (ITE), decompensated heart failure, cardiogenic shock, unstable arrhythmias, nonfatal cardiac arrest, pulmonary edema, stroke, or PAD symptoms increase.

Results:

We evaluated 124 patients (61.3% male; mean age 65.4 years). During the study, 57.9% of patients in the PAD group had an event versus 25.7% in the control group ( P = .011). The ITE was the most observed event (24.2%). After logistic regression, the odds ratio for ITE was 7.4 (95% confidence interval 2.2-25.0, P = .001).

Conclusions:

In patients submitted to noncardiac surgery, abnormal ABI is associated with a higher occurrence of a cardiovascular event.