Analysis of Ankle-Brachial Index, Waist-Hip Ratio, Ejection-Fraction, Obesity, Smoking, Alcohol Habits, Diabetes and Hypertension as Independent Predictors of Complexity and Severity of Coronary Artery Disease


Background: The present study was conducted to examine the association between various coronary risk factors and clinical parameters, with special emphasis on ankle-brachial index, in predicting the severity and complexity of coronary artery disease. Methods: Patients diagnosed with coronary artery disease at our hospital between September-2012 and December-2014 were examined in this study. Selected patients were screened for cardiovascular risk factors including diabetes, hypertension, smoking, and alcohol habits as well as for clinical parameters including body-mass index, waist-hip ratio, ankle-brachial index, and ejection fraction. All patients underwent coronary angiography and were evaluated for severity of coronary artery disease (based on number of vessels involved) and complexity of coronary angiographic lesions (measured by computer-assisted Syntax score calculator). The collected data were analyzed to determine the role of cardiovascular risk factors and clinical parameters as predictors of complexity and severity of coronary artery disease. Results: A total of 211 patients (mean age: 54.64 ± 9.9 years; 81% males) with coronary artery disease were analyzed. Findings revealed that diabetes mellitus (p < 0.001), hypertension (p < 0.001), smoking habits (p = 0.036), and low ankle-brachial index (p < 0.001) were independent predictors of complex coronary artery disease as measured by Syntax score. Significant associations were also evident between severity of coronary artery disease and diabetes mellitus (p < 0.001), hypertension (p < 0.001), and ankle-brachial index (p < 0.001). Conversely, other cardiovascular risk factors including body-mass index, alcohol habits, wait-hip ratio, and ejection fraction did not exhibit significant associations with severity and complexity of coronary artery. Conclusions: The early diagnosis of coronary artery can be predicated by evaluating diabetes, hypertension, and smoking habits in patients presenting with acute coronary syndrome. In addition, ankle-brachial index can be used as an effective non-invasive bed-side tool, as an alternative to Syntax score, in predicting the severity and complexity of coronary artery disease.

Share and Cite:

Cheruku, N. , Naidu Otikunta, A. , Reddy, Y. and Srinivas, R. (2015) Analysis of Ankle-Brachial Index, Waist-Hip Ratio, Ejection-Fraction, Obesity, Smoking, Alcohol Habits, Diabetes and Hypertension as Independent Predictors of Complexity and Severity of Coronary Artery Disease. International Journal of Clinical Medicine, 6, 838-844. doi: 10.4236/ijcm.2015.611110.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Sekhri, T., Kanwar, R.S., Wilfred, R., Chugh, P., Chhillar, M., Aggarwal, R., Sharma, Y.K., Sethi, J., Sundriyal, J., Bhadra, K., Singh, S., Rautela, N., Chand, T., Singh, M. and Singh, S.K. (2014) Prevalence of Risk Factors for Coronary Artery Disease in an Urban Indian Population. BMJ Open, 4, e005346.
[2] Bhatt, H., Turkistani, A., Sanghani, D., Julliard, K. and Fernaine, G. (2015) Do Cardiovascular Risk Factors and Coronary SYNTAX Score Predict Contrast Volume Use During Cardiac Catheterization? Angiology, 66, 933-940.
[3] Kim, J.J., Hwang, B.H., Choi, I.J., Choo, E.H., Lim, S., Kim, J.K., Koh, Y.S., Kim, D.B., Jang, S.W., Cho, E.J., Lee, J.M., Kim, P.J., Cho, J.H., Jung, J.I., Seung, K.B., Min, J.K. and Chang, K. (2015) Impact of Diabetes Duration on the Extent and Severity of Coronary Atheroma Burden and Long-Term Clinical Outcome in Asymptomatic Type 2 Diabetic Patients: Evaluation by Coronary CT Angiography. European Heart Journal—Cardiovascular Imaging, 16, 1065-1073.
[4] Korkmaz, L., Adar, A., Korkmaz, A.A., Erkan, H., Agac, M.T., Acar, Z., Kurt, I.H., Akyuz, A.R. and Celik, S. (2012) Atherosclerosis Burden and Coronary Artery Lesion Complexity in Acute Coronary Syndrome Patients. Cardiology Journal, 19, 295-300.
[5] Yano, M., Miura, S.I., Shiga, Y., Miyase, Y., Suematsu, Y., Norimatsu, K., Nakamura, A., Adachi, S., Nishikawa, H. and Saku, K. (2015) Association between Smoking Habits and Severity of Coronary Stenosis as Assessed by Coronary Computed Tomography Angiography. Heart Vessels, 1-8.
[6] Cassar, A., Poldermans, D., Rihal, C.S. and Gersh, B.J. (2010) The Management of Combined Coronary Artery Disease and Peripheral Vascular Disease. European Heart Journal, 31, 1565-1572.
[7] Falcao, F.J., Rodrigues Alves, C.M., Caixeta, A., de Freitas Guimaraes, L., de Sousa Filho, J.T., Soares, J.A., Helber, I. and Carvalho, A.C. (2013) Relation between the Ankle-Brachial Index and the Complexity of Coronary Artery Disease in Older Patients. Clinical Interventions in Aging, 8, 1611-1616.
[8] Sebastianski, M., Narasimhan, S., Graham, M.M., Toleva, O., Shavadia, J., Abualnaja, S., Tsuyuki, R.T. and McMurtry, M.S. (2014) Usefulness of the Ankle-Brachial Index to Predict High Coronary SYNTAX Scores, Myocardium at Risk, and Incomplete Coronary Revascularization. American Journal of Cardiology, 114, 1745-1749.
[9] Ko, S.H. and Bandyk, D.F. (2013) Interpretation and Significance of Ankle-Brachial Systolic Pressure Index. Seminars in Vascular Surgery, 26, 86-94.
[10] Khan, T.H., Farooqui, F.A. and Niazi, K. (2008) Critical Review of the Ankle Brachial Index. Current Cardiology Reviews, 4, 101-106.
[11] Lamina, C., Meisinger, C., Heid, I.M., Lowel, H., Rantner, B., Koenig, W. and Kronenberg, F. (2006) Association of Ankle-Brachial Index and Plaques in the Carotid and Femoral Arteries with Cardiovascular Events and Total Mortality in a Population-Based Study with 13 Years of Follow-Up. European Heart Journal, 27, 2580-2587.
[12] Resnick, H.E., Lindsay, R.S., McDermott, M.M., Devereux, R.B., Jones, K.L., Fabsitz, R.R. and Howard, B.V. (2004) Relationship of High and Low Ankle Brachial Index to All-Cause and Cardiovascular Disease Mortality: The Strong Heart Study. Circulation, 109, 733-739.
[13] Papa, E.D., Helber, I., Ehrlichmann, M.R., Alves, C.M., Makdisse, M., Matos, L.N., Borges, J.L., Lopes, R.D., Stefanini, E. and Carvalho, A.C. (2013) Ankle-Brachial Index as a Predictor of Coronary Disease Events in Elderly Patients Submitted to Coronary Angiography. Clinics (Sao Paulo), 68, 1481-1487.
[14] McDermott, M.M., Ferrucci, L., Liu, K., Guralnik, J.M., Tian, L., Kibbe, M., Liao, Y., Tao, H. and Criqui, M.H. (2011) Women with Peripheral Arterial Disease Experience Faster Functional Decline than Men with Peripheral Arterial Disease. Journal of the American College of Cardiology, 57, 707-714.
[15] (2005) Abstracts of the 45th Annual Conference on Cardiovascular Disease Epidemiology and Prevention in Association with the Council on Nutrition, Physicial Activity and Metabolism. Washington DC, 29 April-2 May 2006, e184-e296.
[16] Ikeda, N., Kogame, N., Iijima, R., Nakamura, M. and Sugi, K. (2013) Impact of Carotid Artery Ultrasound and Ankle-Brachial Index on Prediction of Severity of SYNTAX Score. Circulation Journal, 77, 712-716.
[17] Papamichael, C.M., Lekakis, J.P., Stamatelopoulos, K.S., Papaioannou, T.G., Alevizaki, M.K., Cimponeriu, A.T., Kanakakis, J.E., Papapanagiotou, A., Kalofoutis, A.T. and Stamatelopoulos, S.F. (2000) Ankle-Brachial Index as a Predictor of the Extent of Coronary Atherosclerosis and Cardiovascular Events in Patients with Coronary Artery Disease. American Journal of Cardiology, 86, 615-618.

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.