Low Ankle-Brachial Index is Associated with Microvascular Coronary Obstruction After Primary PCI

Figures & data

Figure 1 Flowchart of the study population.

Table 1 Sociodemographic, Clinical, Electrocardiographic, Echocardiographic, Laboratory, ABI and Angiographic Characteristics of Our Study Population

Parameters	n= 261
Age (mean±SD) in years	58.79 ± 10.7
Sex, male (%)	219 (83.9)
Smoking (%)	156 (59.8)
Diabetes mellitus (%)	71 (27.2)
Hypertension (%)	85 (32.6)
Ischaemic heart disease (%)	33 (12.6)
Clopidogrel pretreatment (%)	8 (3.1)
Systolic blood pressure in mmHg (mean±SD)	112.49 ± 17.27
Diastolic blood pressure in mmHg (mean±SD)	73.33 ± 11.82
Heart rate in beats/min (mean±SD)	81.98 ± 12.69
Site of infarction
Anterior (%)	161 (61.6)
Inferior (%)	55 (21.1)
Inferoposterior (%)	43 (16.5)
Lateral (%)	2 (0.8)
Ejection fraction (mean±SD)	50.64 ± 8.9
Serum Troponin I in ng/mL (mean±SD)	3.46 ± 1.2
Serum creatinine in mg/dL (mean±SD)	1.09 ± 0.23
Hemoglobin level in mg/dL (mean±SD)	12.44 ± 1.6
ABI (mean±SD)	0.93 ± 0.06
Culprit vessel
LAD (%)	162 (62.1)
LCX (%)	31 (11.8)
RCA (%)	67 (25.7)
Ramus (%)	1 (0.4)
Presence of total occlusion in culprit vessel (%)	235 (90)
Presence of coronary thrombus (%)	62 (23.8)
Number of affected vessels (mean±SD)	1.94 ± 0.77
One (%)	83 (31.8)
Two (%)	113 (43.3)
Three or more (%)	65 (24.9)
Number of stents: mean±SD	1.1 ± 0.38
One (%)	236 (90.4)
Two (%)	20 (7.7)
Three (%)	5 (1.9)
Balloon pre-dilatation (%)	246 (94.3)
MBG:
Grade I (%)	41 (15.7)
Grade II (%)	121 (46.4)
Grade III (%)	99 (37.9)

Abbreviations: ABI, ankle-brachial index; LAD, left anterior descending artery; LCX, left circumflex artery; RCA, right coronary artery; MBG, myocardial blush grade.

Table 2 The Sociodemographic, Clinical, ABI, Electrocardiographic and Echocardiographic, Laboratory and Angiographic Characteristics of the Three Groups

Parameters	Group I (n = 41)	Group II (n = 121)	Group III (n = 99)	P value
Age (mean±SD) in years	60.1 ± 12.0	58.6 ± 10.5	58.6 ± 10.3	0.697
Sex, male (%)	35 (85.4%)	104 (86%)	80 (80.8%)	0.377
Smoking (%)	24 (58.5%)	75 (62%)	57 (57.6%)	0.763
Diabetes mellitus (%)	11 (26.8%)	34 (28.1%)	26 (26.3%)	0.877
Hypertension (%)	16 (39%)	41 (33.9%)	28 (28.3%)	0.049
Ischaemic heart disease (%)	5 (12.2%)	16 (13.2%)	12 (12.1%)	0.929
Clopidogrel pretreatment (%)	1 (2.4)	6 (5)	1 (1)	0.232
Systolic blood pressure (mean±SD) in mmHg	112.88 ± 21.1	111.72 ± 15.3	113.27 ± 17.9	0.794
Diastolic blood pressure (mean±SD) in mmHg	75.38 ± 14.54	72.23 ± 10.62	73.85 ± 11.97	0.297
Heart rate in beats/min (mean±SD)	80.95 ± 10.68	82.11 ± 12.83	82.23 ± 13.36	0.856
Site of infarction				0.006
Anterior (%)	29 (70.8%)	83 (68.6%)	49 (49.5%)
Non-Anterior^+ (%)	12 (29.2%)	38 (31.4%)	50 (50.5%)
Ejection fraction (mean±SD)	45.76 ± 7.7	49.14 ± 8.2	54.48 ± 8.9	<0.001
ABI (mean±SD)	0.89 ± 0.06	0.91 ± 0.05	0.96 ± 0.05	<0.001
Serum Troponin I in ng/mL (mean±SD)	3.89 ± 1.3	3.61 ± 1.2	3.10 ± 1.1	<0.001
Serum creatinine in mg/dL (mean±SD)	1.12 ± 0.3	1.07 ± 0.2	1.10 ± 0.2	0.441
Hemoglobin level in mg/dL (mean±SD)	12.62 ± 1.6	12.24 ± 1.5	12.61 ± 1.7	0.176
Culprit vessel				0.004
LAD (%)	30 (73.1%)	83 (68.6%)	49 (49.5%)
Non-LAD* (%)	11 (26.9%)	38 (31.4%)	50 (50.5%)
Presence of total occlusion (%)	34 (82.9)	112 (92.6)	89 (89.9)	0.205
Presence of coronary thrombus (%)	8 (19.5)	31 (25.6)	23 (23.2)	0.721
Number of affected vessels				0.388
One (%)	12 (29.3%)	44 (36.4%)	27 (27.3%)
More than one (%)	29 (70.7)	77 (63.6%)	72 (72.7%)
Mean±SD	1.95 ± 0.74	1.88 ± 0.78	2.01 ± 0.76	0.434
Number of stents				0.300
One (%)	39 (95.1%)	109 (90.1%)	88 (88.9%)
More than one (%)	2 (4.9%)	12 (9.9%)	11 (11.1%)
Mean±SD	1.05 ± 0.22	1.12 ± 0.37	1.14 ± 0.43	0.414
Balloon pre-dilatation (%)	41 (100%)	113 (93.4%)	92 (92.9%)	0.163

Notes: Bold text indicates statistical significance; ⁺Non-Anterior indicates inferior, inferoposterior and lateral wall myocardial infarctions; *Non-LAD indicates LCX, Ramus and RCA.

Abbreviation: ABI, ankle-brachial index.

Table 3 Logistic Regression Model for the Predictors of Poor MBG

Factors	OR (95% CI)	P value
Age	1.008 (0.978–1.038)	0.614
Sex (male)	1.425 (0.580–3.503)	0.440
Hypertension	2.455 (1.180–5.104)	0.016
ABI < 0.9	6.430 (3.162–13.078)	< 0.001
Serum troponin level (ng/mL)	1.481 (1.135–1.932)	0.004
Ejection fraction	0.892 (0.857–0.928)	< 0.001

Abbreviation: ABI, ankle-brachial index.

Figure 2 ROC curve for ABI to predict poor MBG.