INTERMITTENT CLAUDICATION AND RISK OF CARDIOVASCULAR EVENTS

To determine the natural history of intermittent claudication, 110 pat ients were followed up for a mean period of 24.4 +/-1.2 months. Four p atients died during the follow-up. Of the survivors, 24 experienced a nonfatal cardiovascular event, myocardial infarction being the most fr equent. Cumulative cardiovascular morbidity was 29% at 3 years. Cox pr oportional-hazards analysis showed initial ankle-brachial pressure ind ex (ABPI) as a significant predictor for nonfatal cardiovascular event s (p<0.002). With an initial ABPI >0.70, cardiovascular morbidity rate was 12% compared with 33% for those with Initial ABPI ranging from 0. 70 to 0.50, and 60% for those with ABPI <0.50 (p<0.005). Critical limb ischemia occurred in only four patients, amputation was required in t wo, and arterial reconstruction in five. Of the 85 patients who partic ipated in the treadmill test, maximum walking capacity worsened in 26% and improved in 27%. This study elucidates the neglected area of card iovascular morbidity in intermittent claudication. It has shown that A BPI identifies a subgroup of patients for whom the risk of cardiovascu lar events is especially pronounced. On the other hand, based on objec tive evaluation of the patient status, the relatively benign prognosis for the claudicant limb has been confirmed.