Author + information
- Received January 10, 2013
- Revision received April 18, 2013
- Accepted May 5, 2013
- Published online April 22, 2014.
- Birgit Linnemann, MD∗,†∗ (, )
- Thilo Sutter∗,
- Eva Herrmann, MD‡,
- Sebastian Sixt, MD∗,
- Aljoscha Rastan, MD∗,
- Uwe Schwarzwaelder, MD∗,
- Elias Noory, MD∗,
- Karlheinz Buergelin, MD∗,
- Ulrich Beschorner, MD∗ and
- Thomas Zeller, MD∗
- ∗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
- ‡Institute of Biostatistics and Math, Modeling, Faculty of Medicine, Goethe University Hospital Frankfurt/Main, Frankfurt/Main, Germany
- ↵∗Reprint requests and correspondence:
Dr. Birgit Linnemann, JW Goethe University Hospital Frankfurt/Main, Division of Vascular Medicine, Department of Internal Medicine, Theodor-Stern-Kai 7, D-60590 Frankfurt/Main, Germany.
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)
Dr. Herrmann is a consultant for Roche Pharma and Novartis Pharmaceuticals. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 10, 2013.
- Revision received April 18, 2013.
- Accepted May 5, 2013.
- American College of Cardiology Foundation