Advertisement

Predictive value of ankle-brachial index and PAI-1 in symptomatic intracranial atherosclerotic disease recurrence

      Highlights

      • 73 Intracranial atherosclerotic disease first-ever stroke patients were studied.
      • Presence of new CVEs was assessed every six months.
      • Ankle-brachial index (ABI) and PAI-1 independently predict further strokes.
      • Discrimination power of ABI and ESRS improve in combination with PAI-1.

      Abstract

      Background and purpose

      We prospectively examine the single and combined predictive value of biological and clinical markers in recurrent strokes related to intracranial atherosclerotic disease (ICAD).

      Methods

      In 73 ICAD first-ever stroke patients, ankle-brachial index (ABI) was assessed three months after TIA or stroke together with CRP, Lp-PLA2, ICAM-1, E-selectin and PAI-1 measurements. Appearance of new TIA/stroke was assessed every 6 months.

      Results

      After a median follow-up of 22.4 months, 13 patients (17.8%) suffered a new stroke or TIA. Risk of new cerebrovascular events (CVEs) was associated with lowered ABI (p=0.011), baseline PAI-1>22.52 ng/ml (<0.001), E-selectin>24.75 ng/ml (p=0.008) and ICAM-1>205 ng/ml (p=0.029). The combination of PAI-1 with ABI or ESRS reclassified 55.4% (p<0.005) and 48.3% (p<0.05) of patients between low, high and very high-risk categories.

      Conclusions

      This tentative study shows that ABI and PAI-1 are associated with the risk of new CVEs in symptomatic ICAD patients, and their combination might improve identification of patients at higher risk.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Chimowitz M.I.
        • Lynn M.J.
        • Derdeyn C.P.
        • et al.
        SAMMPRIS Trial Investigators. Stenting versus aggressive medical therapy for intracranial arterial stenosis.
        N Engl J Med. 2011; 365: 993-1003
        • Massot A.
        • Pelegri D.
        • Penalba A.
        • et al.
        Lipoprotein-associated phospholipase A2 testing usefulness among patients with symptomatic intracranial atherosclerotic disease.
        Atherosclerosis. 2011; 218: 181-187
        • Weimar C.
        • Goertler M.
        • Röther J.
        • et al.
        • SCALA Study Group
        Predictive value of the Essen stroke risk score and ankle brachial index in acute ischaemic stroke patients from 85 German stroke units.
        J Neurol Neurosurg Psychiatry. 2008; 79: 1339-1343
        • CAPRIE Steering Committee
        A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE).
        Lancet. 1996; 348: 1329-1339
        • Arenillas J.F.
        • Alvarez-Sabín J.
        • Molina C.A.
        • et al.
        C-reactive protein predicts further ischemic events in first-ever transient ischemic attack or stroke patients with intracranial large-artery occlusive disease.
        Stroke. 2003; 34: 2463-2470
        • Tanne D.
        • Haim M.
        • Boyko V.
        • et al.
        Soluble intercellular adhesion molecule-1 and risk of future ischemic stroke: a nested case-control study from the bezafibrate infarction prevention (BIP) study cohort.
        Stroke. 2002; 33: 2182-2186
        • Matsumoto K.
        • Fujishima K.
        • Moriuchi A.
        • Saishoji H.
        • Ueki Y.
        Soluble adhesion molecule E-selectin predicts cardiovascular events in Japanese patients with type 2 diabetes mellitus.
        Metabolism. 2010; 59: 320-324
        • Sinkovic A.
        • Pogacar V.
        Risk stratification in patients with unstable angina and/or non-ST-elevation myocardial infarction by troponin T and plasminogen-activator-inhibitor-1 (PAI-1).
        Thromb Res. 2004; 114: 251-257
        • Agnelli G.
        • Cimminiello C.
        • Meneghetti G.
        • Urbinati S.
        Polyvascular Atherothrombosis Observational Survey (PATHOS) Investigators. Low ankle-brachial index predicts an adverse 1-year outcome after acute coronary and cerebrovascular events.
        J Thromb Haemost. 2006; 4: 2599-2606
        • Manzano J.J.
        • De Silva D.A.
        • Pascual J.L.
        • Chang H.M.
        • Wong M.C.
        • Chen C.P.
        Associations of ankle-brachial index (ABI) with cerebral arterial disease and vascular events following ischemic stroke.
        Atherosclerosis. 2012; 223: 219-222
        • Busch M.A.
        • Lutz K.
        • Röhl J.E.
        • Neuner B.
        • Masuhr F.
        Low ankle-brachial index predicts cardiovascular risk after acute ischemic stroke or transient ischemic attack.
        Stroke. 2009; 40: 3700-3705
        • Sen S.
        • Lynch Jr., D.R.
        • Kaltsas E.
        • et al.
        Association of asymptomatic peripheral arterial disease with vascular events in patients with stroke or transient ischemic attack.
        Stroke. 2009; 40: 3472-3477
        • Arenillas J.F.
        • Alvarez-Sabín J.
        • Molina C.A.
        • et al.
        Progression of symptomatic intracranial large artery atherosclerosis is associated with a proinflammatory state and impaired fibrinolysis.
        Stroke. 2008; 39: 1456-1463
        • Espinola-Klein C.
        • Rupprecht H.J.
        • Bickel C.
        • et al.
        AtheroGene Investigators. Different calculations of ankle-brachial index and their impact on cardiovascular risk prediction.
        Circulation. 2008; 118: 961-967
        • Pencina M.J.
        • D'Agostino R.B.
        • Vasan R.S.
        Statistical methods for assessment of added usefulness of new biomarkers.
        Clin Chem Lab Med. 2010; 48: 1703-1711
        • Weimar C.
        • Diener H.C.
        • Alberts M.J.
        • et al.
        REduction of Atherothrombosis for Continued Health Registry Investigators. The Essen stroke risk score predicts recurrent cardiovascular events: a validation within the REduction of Atherothrombosis for Continued Health (REACH) registry.
        Stroke. 2009; 40: 350-354
        • Diener H.C.
        • Ringleb P.A.
        • Savi P.
        Clopidogrel for the secondary prevention of stroke.
        Expert Opin Pharmacother. 2005; 6: 755-764
        • McDermott M.M.
        • Liu K.
        • Criqui M.H.
        • et al.
        Ankle-brachial index and subclinical cardiac and carotid disease: the multi-ethnic study of atherosclerosis.
        Am J Epidemiol. 2005; 162: 33-41
        • Newman A.B.
        • Shemanski L.
        • Manolio T.A.
        • et al.
        Ankle-arm index as a predictor of cardiovascular disease and mortality in the cardiovascular health study. The Cardiovascular Health Study Group.
        Arterioscler Thromb Vasc Biol. 1999; 19: 538-545
        • Tsai A.W.
        • Folsom A.R.
        • Rosamond W.D.
        • Jones D.W.
        Ankle-brachial index and 7-year ischemic stroke incidence: the ARIC study.
        Stroke. 2001; 32: 1721-1724
        • Alzamora M.T.
        • Baena-Díez J.M.
        • Sorribes M.
        • et al.
        PERART study. Peripheral arterial disease study (PERART): prevalence and predictive values of asymptomatic peripheral arterial occlusive disease related to cardiovascular morbidity and mortality.
        BMC Public Health. 2007; 7: 348
        • Tzoulaki I.
        • Murray G.D.
        • Lee A.J.
        • Rumley A.
        • Lowe G.D.
        • Fowkes F.G.
        C-reactive protein, interleukin-6, and soluble adhesion molecules as predictors of progressive peripheral atherosclerosis in the general population: Edinburgh artery study.
        Circulation. 2005; 16: 976-983
        • Shlipak M.G.
        • Ix J.H.
        • Bibbins-Domingo K.
        • Lin F.
        • Whooley M.A.
        Biomarkers to predict recurrent cardiovascular disease: the heart and soul study.
        Am J Med. 2008; 121: 50-57