{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T11:10:21Z","timestamp":1758280221007,"version":"3.41.2"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2020,6,2]]},"abstract":"\n Background<\/jats:title>\n \n Ankle\u2010brachial indexes (\n ABI<\/jats:styled-content>\n ) are a noninvasive diagnostic tool for peripheral arterial disease and a marker of increased cardiovascular risk.\n ABI<\/jats:styled-content>\n is calculated using the highest systolic blood pressure of the 4 ankle arteries (bilateral dorsalis pedis and posterior tibial). Accordingly, patients may be assigned a normal\n ABI<\/jats:styled-content>\n when the result would be abnormal if calculated using one of the other blood pressure readings. Cardiovascular outcomes for patients with discordant\n ABI<\/jats:styled-content>\n s are undescribed.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n We performed a retrospective study of patients who underwent\n ABI<\/jats:styled-content>\n measurement for any indication between January 1996 and June 2018. Those with normal\n ABI<\/jats:styled-content>\n s (1.00\u20131.39) were included. We compared patients with all 4 normal\n ABI<\/jats:styled-content>\n s (calculated using all 4 ankle arteries; n=15\u00a0577, median age 64.0 years, 54.4% men) to those with discordant\n ABI<\/jats:styled-content>\n s (at least 1 abnormal\n ABI<\/jats:styled-content>\n \u22640.99; n=2095, median age 66.0 years, 47.8% men). The outcomes assessed were ischemic stroke, myocardial infarction, and all\u2010cause mortality. Compared with patients with concordant normal\n ABI<\/jats:styled-content>\n s, patients with discordant\n ABI<\/jats:styled-content>\n s were older; women; smoked; and had chronic kidney disease, coronary artery disease, diabetes mellitus, chronic obstructive pulmonary disease, hypertension, or prior stroke. Patients with discordant\n ABI<\/jats:styled-content>\n s had a greater risk of myocardial infarction (hazard ratio [HR], 1.31; 95%\n CI,<\/jats:styled-content>\n 1.10\u20131.56), ischemic stroke (\n HR,<\/jats:styled-content>\n 1.53; 95%\n CI,<\/jats:styled-content>\n 1.37\u20131.72), and all\u2010cause mortality (\n HR,<\/jats:styled-content>\n 1.27; 95%\n CI,<\/jats:styled-content>\n 1.16\u20131.39), including after adjustment for baseline comorbidities.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Discordant\n ABI<\/jats:styled-content>\n results were associated with an increased risk of myocardial infarction, stroke, and all\u2010cause mortality in the studied population. Clinicians should examine\n ABI<\/jats:styled-content>\n calculations using all 4 ankle arteries to better characterize a patient's cardiovascular risk.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.119.015398","type":"journal-article","created":{"date-parts":[[2020,5,16]],"date-time":"2020-05-16T09:03:14Z","timestamp":1589619794000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Discordant Values in Lower Extremity Physiologic Studies Predict Increased Cardiovascular Risk"],"prefix":"10.1161","volume":"9","author":[{"given":"Christine","family":"Firth","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Scottsdale AZ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew S.","family":"Tseng","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester 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Mayo Clinic Rochester MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy","family":"Pollak","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Jacksonville FL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Liedl","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Wennberg","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fadi Elias","family":"Shamoun","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Scottsdale 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