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2015 ; 94
(31
): e1277
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Discordant Diagnosis of Lower Extremity Peripheral Artery Disease Using American
Heart Association Postexercise Guidelines
#MMPMID26252297
Mahe G
; Pollak AW
; Liedl DA
; Cohoon KP
; Mc Carter C
; Rooke TW
; Wennberg PW
Medicine (Baltimore)
2015[Aug]; 94
(31
): e1277
PMID26252297
show ga
To determine whether postexercise criteria for peripheral artery disease (PAD)
diagnosis recommended by the American Heart Association (AHA) identifies the same
group of PAD patients.Diagnosis of PAD is performed using ankle-brachial index at
rest (resting-ABI). When resting-ABI is not contributive, an AHA scientific
statement recommend to use 1 of 2 following criteria: a postexercise ABI decrease
of greater than 20% or a postexercise ankle pressure decrease of greater than
30?mm Hg.Between 1996 and 2012, 31,663 consecutive patients underwent
lower-extremity arterial study at Mayo Clinic. Among them, only unique patients
who had exercise treadmill testing were analyzed. In this retrospective analysis,
resting-ABI, postexercise ABI, and postexercise decrease of ankle pressure
measured at 1-minute were measured in each patient. We conducted an analysis of
agreement between postexercise criteria expressing the agreement separately for
the positive and the negative ratings. Twelve thousand three hundred twelve
consecutive patients were studied with a mean age of 67?±?12 years, 61% male.
According to resting-ABI, 4317 (35%) patients had PAD. In the whole population,
if a clinician diagnoses "PAD" with 1 postexercise criterion, the probability
that other clinicians would also diagnose "PAD" is 74.3%. If a clinician
diagnoses "no PAD", the probability that other clinicians would also diagnose "no
PAD" is 82.4%. In the patients to be of potential benefit from treadmill test
when the resting-ABI?>?0.90, if a clinician diagnoses "PAD" with 1 postexercise
criterion, the probability that other clinicians would also diagnose "PAD" is
58.4% whereas if a clinician diagnoses "no PAD," the probability that other
clinicians would also diagnose "no PAD" is 87.5%.Postexercise criteria do not
identify the same group of PAD patients. In our opinion, postexercise criteria to
define PAD deserve additional study.