Lee JY, Lee SJ, Lee SW, et al. - An extended follow‐up over 7 years in patients with significant coronary artery disease revealed that asymptomatic abnormal ankle–brachial index (ABI) was related to sustained and increased incidence of composite of all‐cause death/myocardial infarction (MI)/stroke, all‐cause death, MI, and stroke.

• Among 2,424 consecutive patients without history of claudication or peripheral artery disease who had significant coronary artery disease, evaluation of ABI was performed.

• A composite of all‐cause death, MI, and stroke assessed over 7 years (extended follow-up) was the primary outcome.

• Follow‐up revealed a significantly higher rate of the primary outcome in the abnormal ABI (ABI ≤0.9 or ≥1.4) group vs in the normal ABI group.

• A significantly higher risk of composite of all‐cause death/MI/stroke was observed in the abnormal ABI group vs the normal ABI group, post-adjustment with multivariable Cox proportional hazards regression analysis (hazard ratio [HR], 2.07) and propensity score–matched analysis (HR, 1.97).

• Additionally, a higher risk of all‐cause death, MI, and stroke, but not repeat revascularization, was noted in the abnormal ABI group.