Have clinicians been wrong about how they diagnose PAD?
The ankle-brachial index (ABI), a noninvasive diagnostic test for peripheral artery disease (PAD) may provide even more value than clinicians realize, according to new data published in JACC.[1]
The study’s authors noted that an ABI value of 0.90 or lower is typically seen as a positive test for PAD. An ABI of 0.91 to 1.00, meanwhile, is seen as “borderline.”
But what is the real difference between PAD and borderline PAD? Is it really OK to hold off on treating a borderline patient? To learn more, the group evaluated data from a “large, diverse cohort” of nearly 225,000 U.S. veterans.
Overall, the authors found that even borderline PAD patients with an ABI in that 0.91-1.00 range were associated with an increased risk of major adverse limb events (MALE) compared to patients with a normal ABI. This same trend remained when focusing exclusively on women, white patients or Black patients.
The authors identified these same trends—borderline patients facing an increased risk—when looking at major amputation rates, total amputation rates and revascularization rates. In addition, major amputation, total amputation and revascularization were all slightly higher among men than women in all ABI categories.
“For decades, clinicians have reassured patients with borderline ABI values that they were nearly normal,” wrote first author Aaron W. Aday MD, MSc, director, vascular medicine, Vanderbilt University Medical Center, and colleagues. “These data suggest otherwise. The ABI, rather than treated as a binary test, is better understood as a continuum—one that captures the earliest signals of limb threat. Recognizing this continuum offers an opportunity for earlier prevention and a new respect for a measure hiding in plain sight.”
Click here to read more in JACC, the flagship journal of the American College of Cardiology.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.