Elevated Cardiac Troponin T Is Associated With Higher Mortality and Amputation Rates in Patients With Peripheral Arterial Disease

Study Questions:

What is the prognostic impact of an elevated cardiac troponin T (cTnT) in patients with peripheral arterial disease (PAD)?

Methods:

The authors measured baseline cTnT levels in 1,041 patients undergoing peripheral vascular intervention (PVI) for symptomatic PAD. The cohort was comprised of 653 males and 388 females, with an average age of 70.7 ± 10.8 years.

Results:

At baseline, measurable cTnT levels (≥0.01 ng/ml) were detected in 21.3% of the cohort. 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%; p < 0.001), myocardial infarction (4.1% vs. 1.1%; p = 0.003), and amputation (10.1% vs. 2.4%; p < 0.001) at 1-year follow-up. In adjusted Cox regression models, cTnT level ≥0.01 ng/ml was an independent predictor of total mortality (hazard ratio [HR], 8.14; 95% confidence interval [CI], 3.77-17.6; p < 0.001) and amputation (HR, 3.71; 95% CI, 1.33-10.3; p = 0.012).

Conclusions:

The authors concluded that patients with PAD commonly have elevation in troponin levels. An elevated troponin is associated with a poor long-term outcome.

Perspective:

An elevation of troponin in the absence of an acute coronary syndrome has been demonstrated to be associated with an increased risk of death in patients with multiple noncardiac disorders. This is the first study to demonstrate that troponin elevation is common in patients undergoing PVI for symptomatic PAD, and is associated with an increased long-term mortality and morbidity. Further studies are warranted to confirm this association and define measures to reduce the adverse long-term mortality hazard.

Clinical Topics: Acute Coronary Syndromes, Invasive Cardiovascular Angiography and Intervention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), ACS and Cardiac Biomarkers, Interventions and ACS, Interventions and Vascular Medicine

Keywords: Acute Coronary Syndrome, Myocardial Infarction, Follow-Up Studies, Metacarpophalangeal Joint, Peripheral Arterial Disease, Angioplasty, Balloon, Coronary, Peripheral Vascular Diseases, Prognosis, Cytoskeletal Proteins, Proportional Hazards Models, Biological Markers, Cardiovascular Diseases, Confidence Intervals, Troponin


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