ARYA Atherosclerosis Journal

Association of SYNTAX score, ankle-brachial index, and toe-brachial index with peripheral arterial disease following CABG

Document Type : Original Article

Authors

Jamal Moosavi 1
Ali Mohamad Nasirian 1
Amir Ghaffari Jolfayi 1
Parham Sadeghipour 1
Bahram Mohebi 1
Seyed Mohammadjavad Hosseini 2
Ermia Tabandeh 2
Roya Hamrahi 2
Amin Elahifar 2
Vida Hamrahi 2
Mansoor Namazi 2
Enayatollah Noori 3
Abdolreza Dayani 2

1 Vascular Disease and Thrombosis Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

2 Rajaie Cardiovascular Medical and Research Center, Rajaie School of Medicine, Iran University of Medical Sciences, Tehran, Iran

3 General Physician, Qom University of Medical Sciences, Qom, Iran

10.48305/arya.2026.45449.3077
Abstract
BACKGROUND: Peripheral arterial disease (PAD) is a common comorbidity in patients undergoing coronary artery bypass grafting (CABG) and is associated with increased morbidity. Early identification of PAD in this population is clinically important; however, the relationship between coronary disease complexity and peripheral arterial involvement remains unclear.
This study aimed to evaluate the association of the SYNTAX score, ankle–brachial index (ABI), and toe–brachial index (TBI) with the development of peripheral arterial disease following CABG.
METHODS: In this retrospective study, 87 patients who underwent CABG were evaluated four years after surgery for the presence of PAD. Baseline SYNTAX score, ABI, and TBI were measured prior to CABG. PAD was diagnosed based on clinical symptoms in combination with abnormal ABI and/or TBI findings and was confirmed by Doppler ultrasonography when indicated. Associations between SYNTAX score, ABI, TBI, and PAD were analyzed using appropriate statistical tests.
RESULTS: During the follow-up period, 7 patients (8.0%) developed PAD. Diabetes mellitus was significantly more prevalent among patients with PAD compared to those without PAD (85.7% vs. 45.0%, P = 0.039). Right ABI (P = 0.005), left TBI (P = 0.008), and right TBI (P = 0.010) were significantly associated with PAD, whereas left ABI was not. Although the SYNTAX score was not directly associated with PAD incidence, higher SYNTAX scores were significantly correlated with greater reductions in both left ABI (r = -0.296, P = 0.005) and right ABI (r = -0.220, P = 0.040) 4 years after CABG.
CONCLUSION: Peripheral arterial disease following CABG was significantly associated with diabetes mellitus and with lower ABI and TBI values, particularly in the right lower extremity. While the SYNTAX score was not directly associated with PAD occurrence, it was correlated with longitudinal declines in ABI, suggesting an association between coronary disease complexity and systemic vascular dysfunction.

Keywords

Peripheral Artery Disease
Coronary Artery Bypass Surgery
Coronary SYNTAX Score
Ankle Brachial Index
Toe Brachial Index
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ARYA Atherosclerosis Journal
Volume 22, Issue 3
May and June 2026
Pages 46-52

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