뇌경색 환자의 1년 예후 예측 인자로써의 발목-상완 혈압 지수

Abstract

Background and aims: Peripheral arterial steno-occlusive disease (PAD) reduces the functional activity and increases the rate of the cardiovascular death in the elderly. Aim of our study was to know whether the presence of PADin stroke patients affects the prognosis of disability or cardiovascular events within one year after discharge. Methods : From April 2008 to March 2009, consecutive first ever stroke patients above 50 years old without any PAD history were enrolled after a full explanation of this study.PAD was defined with low ankle-brachial index (less than 0.9) measured by an automatic device. Clinical data associated stroke were collected from medicalrecords. The disability of stroke patients was evaluated with modified Rankin scale (mRS) at discharge day and 1year after. Poor prognosis group was defined as if the grade of scale at 1 year increased one level or more in mRS. Also, cardiovascular events(recurrent ischemic stroke, intracranial hemorrhage, myocardial infarction, and sudden cardiac arrest) and cause of death or the worse were investigated. Results: Thirty four of 192 patients (17.7%) were diagnosed as PAD. From among these, 14 patients (41.2%) were classified as poor prognosis and 7 (20.6%) were died. In multiple regression analysis, PAD was an independent factor associated with poor prognosis (p=0.010, OR 3.32, 95% CI 1.335-8.248) after adjusted with age, discharge NIHSS (National institute health stroke scale), dyslipidemia, steno-occlusion of internal carotid artery and posterior cerebral artery. Deathwithin one year was associated with PAD (p=0.015) in univariate analysis. However, in multivariate analysis, PAD was not a independent factor (p=0.130, OR2.511 95% CI 0.762-8.274). Cardio-vascular events were not associated with PAD (p=0.078). Conclusions: The presence of PAD in stroke patients suggests a poor recovery, but may be not a predictor of death or cardiovascular events within one year.

Key words: Ankle brachial index, Peripheral artery disease, Ischemic stroke, Prognosis