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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.

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Department 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:
Department of Angiology, University Heart Center Bad Krozingen, Bad Krozingen, Germany.
Institute of Biostatistics and Math, Modeling, Faculty of Medicine, Goethe University Hospital Frankfurt/Main, Frankfurt/Main, Germany.



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).


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


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.


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).


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).


amputation; mortality; peripheral arterial disease; troponin T

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