Diagnostic value of simultaneous brachial and ankle blood pressure measurements for the extent and severity of coronary artery disease as assessed by myocardial perfusion imaging

Background Although the simultaneous measurement of brachial and ankle blood pressure is a simple method of evaluating atherosclerosis, its diagnostic value for coronary artery disease (CAD) is undetermined. Methods and Results To evaluate the diagnostic value of ankle-brachial pressure index (ABI) and brachial-to-ankle pulse wave velocity (baPWV), 334 consecutive patients with suspected CAD were evaluated. Patients with a previous myocardial infarction or coronary intervention were not included. The magnitude of myocardial ischemia was evaluated by myocardial perfusion imaging. Using a 20-segment model, the percent of ischemic segments to total segments was expressed as %myocardium ischemic. In patients with 1, 2 and 3 coronary risk factors, %myocardium ischemic was 2.7+/-0.4, 4.0+/-0.5, 7.9+/-0.8%, respectively (p<0.0001 for trend). Performing ABI with a cutoff of 1, the %myocardium ischemic was similar in patients with 1 or 2 risk factors. In patients with 3 coronary risk factors, however, an ABI <1 reflected greater %myocardium ischemic than an ABI greater than or equal to1 (10.1+/-1.3, 6.6+/-1.0%; p=0.03). No such additional value was observed with baPWV. Conclusions The addition of simultaneous brachial and ankle blood pressure measurements will help further stratify patients with multiple risk factors. Although this approach is simple, it facilitates the identification of high-risk patients who require aggressive treatment because >10% myocardium ischemic is regarded as a scintigraphic indicator for coronary revascularization.