{
  "abstract": "Background: Ankle-brachial index (ABI) is associated with systemic vascular disease, but its incremental predictive value depends on the clinical comparator, endpoint and validation design. Objective: To test whether a bilateral ABI feature block improves a nonlaboratory clinical benchmark for ten-year death from diseases of the heart or cerebrovascular disease, and whether a limited nonlinear learner improves the same chronological evaluation. Methods: We rebuilt public NHANES 1999-2004 examination data linked to the 2019 public-use mortality file. Adults aged at least 40 years with bilateral ABI values in [0.20, 2.50] and ascertainable 120-month status formed a survey-weighted analytic subset. Models were trained on 1999-2002, tuned within development cycles, and evaluated on 2003-2004. Primary models were linear clinical logistic regression, flexible clinical logistic regression, flexible clinical plus ABI regression, and histogram gradient boosting plus ABI. Point estimates used full evaluation weights; conditional intervals used 32-replicate Fay balanced repeated replication with 15 design degrees of freedom. The study was not prospectively registered. Results: The corrected cohort contained 6,807 participants (4,617 development; 2,190 temporal evaluation) and 409 primary events, including 139 in evaluation. Evaluation AUROC was 0.834 for flexible clinical regression and 0.834 after ABI addition. The paired ABI increment was -0.0007 (95% CI -0.0047 to 0.0032); the paired Brier difference was 0.0008 (95% CI -0.0003 to 0.0018). Boosting plus ABI had AUROC 0.822; versus regression with the same predictor block, its AUROC difference was -0.0117 (95% CI -0.0379 to 0.0144). Its Brier difference was -0.000661 (95% CI -0.001322 to -7.53e-08); the upper limit was extremely close to zero. Neither primary hypothesis of improvement in both metrics was supported. Conclusions: In this corrective, exploratory chronological benchmark, bilateral ABI did not improve discrimination or Brier score beyond a matched flexible clinical model. The result does not negate ABI associations, establish equivalence, or support treatment decisions. It supports transparent evaluation of incremental information in a new cohort rather than claims of clinical utility.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "name": "L. You"
    },
    {
      "name": "Y. Guo"
    },
    {
      "name": "X. Zhong"
    },
    {
      "name": "Z. Peng"
    },
    {
      "name": "W. Wang"
    },
    {
      "name": "L. Shen"
    },
    {
      "affs": [
        0
      ],
      "name": "J. Ge"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/5r7jvzxvwhdhx.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.30.26366960",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.10.30.26366960v1.full",
  "id": "5r7jvzxvwhdhx",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.10.30.26366960v1",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "cardiovascular medicine"
    ]
  ],
  "openalex": null,
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.10.30.26366960v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-30",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/5r7jvzxvwhdhx.ris",
  "sources": [
    {
      "first_seen": "2026-11-03T00:20:25Z",
      "native_id": "10.64898/2026.10.30.26366960",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.10.30.26366960v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:cardiovascular medicine",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Incremental value of bilateral ankle-brachial index for ten-year heart and cerebrovascular mortality prediction: an exploratory temporal benchmark in NHANES",
  "title_text": "Incremental value of bilateral ankle-brachial index for ten-year heart and cerebrovascular mortality prediction: an exploratory temporal benchmark in NHANES",
  "type": "preprint",
  "updated_at": "2026-11-04T00:21:00Z",
  "url": "https://research.draconitic.com/paper/5r7jvzxvwhdhx",
  "venue": "medRxiv",
  "versions": []
}