Background: Peripheral artery disease (PAD) is usually caused by atherosclerosis. Patients with acute myocardial infarction (AMI) and cerebrovascular accident (CVA) are at increased risk. In symptomatic cases ABPI is a simple non-invasive test to diagnose PAD. In the present study we aim to assess the utility of alternative formula for ABPI as a screening tool for asymptomatic PAD in AMI and CVA. Methods: This is a prospective observational study. Patients were recruited from Medicine IPD and ER in MGM Medical College & LSK Hospital, KIshanganj, Bihar. Patients included were those of AMI or CVA. Sample size calculated was to be 243. ABPI was measured using a handheld Doppler of 8 MHz and a standard sphygmomanometer. Statistical analysis was performed using SPSS software. Results: A mean value of 0.9+/-0.073 was observed. In this study 63.2% was found to have abnormal ABPI (less than 0.9) which is nearly 2/3rd of the study population. The ROC was plotted against sensitivity and specificity for the co-morbidities considered. The area under the curve was statistically significant for both acute MI and acute CVA with a positive correlation. Conclusion: In patients with acute MI and CVA, alternative ABPI is a good screening tool to detect asymptomatic PAD. However, further studies are required in a larger population to confirm its utility.