Sensitivity and specificity of the ankle—brachial index to diagnose peripheral artery disease: a structured review

• Published in: Vascular Medicine 2010-10, Vol.15 (5), p.361-369
• Main Authors: Dachun Xu, Jue Li, Liling Zou, Yawei Xu, Dayi Hu, Pagoto, Sherry L, Yunsheng Ma
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Ankle Brachial Index - standards; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular system; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Peripheral Arterial Disease - diagnosis; Peripheral Arterial Disease - physiopathology; Predictive Value of Tests; Prognosis; Radionuclide investigations; Sensitivity and Specificity; Severity of Illness Index; Young Adult
• ISSN: 1358-863X; 1477-0377
• DOI: 10.1177/1358863X10378376

The ankle—brachial index (ABI) is a simple, inexpensive diagnostic test for peripheral artery disease (PAD). However, it has shown variable accuracy for identification of significant stenosis. The authors performed a structured review of the sensitivity and specificity of ABI ≤ 0.90 for the diagnosis of PAD. MEDLINE, EMBASE, Cochrane databases, Science Citation Index database, and Biological Abstracts database were searched for studies of the sensitivity and specificity of using ABI ≤ 0.90 for the diagnosis of PAD. Eight studies comprising 2043 patients (or limbs) met the inclusion criteria. The result indicated that, although strict inclusion criteria on studies were formulated, different reference standards were found in these studies, and methods of ABI determination and characteristics of populations varied greatly. A high level of specificity (83.3—99.0%) and accuracy (72.1—89.2%) was reported for an ABI ≤ 0.90 in detecting ≥ 50% stenosis, but there were different levels of sensitivity (15—79%). Sensitivity was low, especially in elderly individuals and patients with diabetes. In conclusion, the test of ABI ≤ 0.90 can be a simple and useful tool to identify PAD with serious stenosis, and may be substituted for other non-invasive tests in clinical practice.