Importance of the Ankle - Brachial

iabetes mellitus (DM) is a major risk factor among typical coronary risk factors that must be considered in the primary and secondary prevention of coronary artery disease (CAD).1–3 The prognosis of diabetic patients without known CAD is reportedly similar to those with previous myocardial infarction.4,5 The diagnostic limitation for CAD in this high-risk group is that clinical symptoms are atypical or even absent,6,7 and routine screening tests such as stress myocardial perfusion imaging (MPI) are not effective.8 In contrast, the development of simultaneous brachial and ankle blood pressure measurements enables the easy evaluation of the ankle-brachial pressure index (ABI), which is reported to be a diagnostic and prognostic marker of atherosclerosis.9,10 We hypothesized that if this simple marker can increase the likelihood of diagnosing CAD in diabetic patients, the diagnostic yields of MPI might be improved with a combined approach using ABI and MPI. Accordingly, we retrospectively evaluated patients with suspected CAD who underwent both simultaneous brachial and ankle blood pressure measurements and stress MPI to evaluate the diagnostic value of ABI in diabetic patients.