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J Am Coll Cardiol. 2014 Apr 22;63(15):1529-38. doi: 10.1016/j.jacc.2013.05.059. Epub 2013 Jun 21.

Elevated cardiac troponin T is associated with higher mortality and amputation rates in patients with peripheral arterial disease.

Author information

  • 1Department of Angiology, University Heart Center Bad Krozingen, Bad Krozingen, Germany; Division of Vascular Medicine, Department of Internal Medicine, Goethe University Hospital Frankfurt/Main, Frankfurt/Main, Germany. Electronic address: Birgit.Linnemann@kgu.de.
  • 2Department of Angiology, University Heart Center Bad Krozingen, Bad Krozingen, Germany.
  • 3Institute of Biostatistics and Math, Modeling, Faculty of Medicine, Goethe University Hospital Frankfurt/Main, Frankfurt/Main, Germany.

Abstract

OBJECTIVES:

The aim of the present study was to evaluate whether elevated cardiac troponin T (cTnT) was independently associated with an increased all-cause mortality or risk of cardiovascular events and amputation among patients with peripheral arterial disease (PAD).

BACKGROUND:

PAD patients often have impaired renal function, and the blood concentration of cardiac troponin often increases with declining glomerular filtration rate.

METHODS:

The cohort consisted of 1,041 consecutive PAD patients (653 males, 388 females, age 70.7 ± 10.8 years, Rutherford stages 2 to 5) undergoing endovascular peripheral revascularization.

RESULTS:

At baseline, measurable cTnT levels (≥0.01 ng/ml) were detected in 21.3% of individuals. Compared with patients who had undetectable cTnT levels, those with cTnT levels ≥0.01 ng/ml had higher rates for mortality (31.7% vs. 3.9%, respectively; p < 0.001), myocardial infarction (4.1% vs. 1.1%, respectively; p = 0.003), and amputation (10.1% vs. 2.4%, respectively; p < 0.001) during a 1-year follow-up. In adjusted Cox regression models, cTnT levels ≥0.01 ng/ml were associated with increased total mortality (hazard ratio [HR]: 8.14; 95% confidence interval [CI]: 3.77 to 17.6; p < 0.001) and amputation rates (HR: 3.71; 95% CI: 1.33 to 10.3; p = 0.012).

CONCLUSIONS:

cTnT is frequently elevated in PAD patients and is associated with higher event rates in terms of total mortality and amputation. Even small cTnT elevations predict a markedly increased risk that is independent of an impaired renal function. (Troponin T as Risk Stratification Tool in Patients With Peripheral Arterial Occlusive Disease; NCT01087385).

Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

amputation; mortality; peripheral arterial disease; troponin T

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PMID:
23792625
[PubMed - indexed for MEDLINE]
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