on May 5, 2005
Published online before print May 5, 2005, doi: 10.1161/01.ATV.0000168911.78624.b7
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Submitted on January 5, 2005
Accepted on April 22, 2005
The Sensitivity and Specificity of the Ankle-Brachial Index to Predict Future Cardiovascular Outcomes. A Systematic Review
Anand V. Doobay and Sonia S. Anand *
From the Department of Medicine and Population Health Research Institute, McMaster University, Hamilton Ontario, Canada.
* To whom correspondence should be addressed. E-mail: anands{at}mcmaster.ca.
Objective--The ankle-brachial index is the ratio of the ankle and the brachial systolic blood pressure and is used to assess individuals with peripheral arterial disease. An ankle-brachial index <0.90 suggests the presence of peripheral arterial disease and is a marker of cardiovascular risk. To determine the sensitivity and specificity of an ankle-brachial index <0.90 to predict future cardiovascular events, including coronary heart disease, stroke, and death.
Methods and Results--We conducted a systematic review of the literature and included studies that used an ankle-brachial index cutoff between 0.80 and 0.90 to classify patients with or without peripheral arterial disease, followed patients prospectively, and recorded cardiovascular outcomes (ie, myocardial infarction, stroke, or mortality). Data were combined using a random-effects model meta-analysis to determine the sensitivity, specificity, relative risks, and likelihood ratios of a low ankle-brachial index to predict future cardiovascular disease. A total of 22 studies were identified, 13 were excluded, and 9 studies were included in the meta-analysis. The sensitivity and specificity of a low ankle-brachial index were 16.5% and 92.7% for incident coronary heart disease, 16.0% and 92.2% for incident stroke, and 41.0% and 87.9% for cardiovascular mortality, respectively. The corresponding positive likelihood ratios were 2.53 (95% CI, 1.45 to 4.40) for coronary heart disease, 2.45 (95% CI, 1.76 to 3.41) for stroke, and 5.61 (95% CI, 3.45 to 9.13) for cardiovascular death.
Conclusion--The specificity of a low ankle-brachial index to predict future cardiovascular outcomes is high, but its sensitivity is low. The ankle-brachial index should become part of the vascular risk assessment among selected individuals.
Key words: atherosclerosis • cardiovascular disease • ankle-brachial index • diagnostic test • systematic review
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