الفهرس 
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Abstract
Background : Atherosclerosis -the most common cause of mortality and morbidity worldwide- is considered a generalized process which affects coronary, cerebral, and peripheral arteries of the lower extremities.Evidence indicated the relation between peripheral arterial disease (PAD) and the occurrence of cardiovascular disease and coronary events in patients with or without known coronary artery disease (CAD).Previous investigations have shown that the ankle-brachial pressure index (ABPI), a quick and useful tool for assessing and evaluating the presence of peripheral arterial disease (PAD) of the lower extremities, is a powerful predictor of mortality.PAD is associated with an increased incidence of multivessel and obstructive CAD. The mentioned relationship is independent of the presence of other cardiovascular risk factors. Consequently, there is increasing interest in ABPI as a noninvasive tool capable of identifying subclinical atherosclerosis including coronary artery disease (CAD).
Aim of the work: The aim of the study is to estimate the role of ankle-brachial pressure index in predicting severity of coronary artery disease in diabetic and non diabetic patients.
Patents&Methods : The study included 120 patients with coronary stenotic lesions, proved by coronary angiography, in the cardiac catheterization laboratory of the Faculty of medicine, Zagazig university hospital, during the period from November 2011 to June 2012. We divided the patients into 2 groups; group (1) which included patients with PAD (ABI>0.9) and group (2) which included patients with no PAD (ABI< or =0.9). We divided the patients into 4 groups; group (A) included patients with no PAD (ABI< or =0.9) and no DM, group (B) included patients with no PAD (ABI< or =0.9) and with DM, group (C) included patients with PAD (ABI>0.9) and with no DM and group (D) included patients with PAD (ABI>0.9) and with DM.
All patients were subjected to all of the following: Complete history taking, Full general and local examination, ECG analysis, Ankle-brachial pressure index measurement, Echocardiography, Coronary Angiography and Calculation of Gensini score.
Results: Hypertension, DM and smoking were significantly higher in patients with PAD (ABI > 0.9) than patients with no PAD (ABI< or =0.9) (p-value >0.05). The mean Gensini score, the mean number of affected coronary vessels, the mean number of coronary artery lesions and the percentage of coronary artery CTO were significantly higher in patients with PAD (ABI > 0.9) (highly significant, p-value >0.001). Hypertension was significantly higher in diabetic patients with PAD (p-value >0.05). Non diabetic patients with PAD had the highest mean age and the highest percentage of current smokers. There was no significant difference between diabetic patients with PAD and non diabetic patients with PAD regarding the mean Gensini score, the mean number of affected coronary vessels, the mean number of coronary artery lesions and the percentage of coronary artery CTO (p-value >0.05).
Conclusion: ABI had a significant relationship with the degree of CAD severity. Therefore ABI seems to be a reliable independent prognostic marker of CAD severity in diabetic and non diabetic patients.