Predictive value of abnormal ankle-brachial index in patients with diabetes: A meta-analysis.

Abstract Aims This meta-analysis aimed to examine the association of abnormal ankle brachial index (ABI) with adverse prognosis in patients with diabetes. Methods We systematically searched PubMed and Embase databases from inception to October 31, 2020 for observational studies investigating the predictive utility of abnormal ABI in patients with diabetes. The normal ABI is usually defined by 0.9–1.3 or 1.4. Results Data were collected from 9 studies involving 9673 patients. When compared with the reference normal ABI, abnormal ABI was associated with a higher risk of cardiovascular mortality (risk ratio [RR] 1.98; 95% confidence intervals [CI] 1.66–2.37), all-cause mortality (RR 2.12; 95% CI 1.81–2.49), and major adverse cardiovascular events ([MACEs] RR 2.37; 95% CI 1.73–3.26). Subgroup analysis indicated that the pooled RR of cardiovascular mortality was similar in individuals with abnormally low ABI (RR 1.98; 95% CI 1.64–2.39) or high ABI (RR 2.00; 95% CI 1.12–3.59). Conclusions Abnormal ABI independently predicts subsequent risk of cardiovascular or all-cause mortality and MACEs in patients with diabetes. However, the predictive role of abnormal ABI is largely dominated by the low ABI rather than the high ABI.