Elevated Cardiac Troponin T Is Associated With Higher Mortality and Amputation Rates in Patients With Peripheral Arterial Disease
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 h...
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| Veröffentlicht in: | Journal of the American College of Cardiology 2014-04, Vol.63 (15), p.1529-1538 |
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| creator | Linnemann, Birgit, MD Sutter, Thilo Herrmann, Eva, MD Sixt, Sebastian, MD Rastan, Aljoscha, MD Schwarzwaelder, Uwe, MD Noory, Elias, MD Buergelin, Karlheinz, MD Beschorner, Ulrich, MD Zeller, Thomas, MD |
| description | 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 ) |
| doi_str_mv | 10.1016/j.jacc.2013.05.059 |
| format | Article |
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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 )</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2013.05.059</identifier><identifier>PMID: 23792625</identifier><identifier>CODEN: JACCDI</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Aged ; Amputation ; Amputation - trends ; Angina pectoris ; Ankle Brachial Index ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology ; Cardiology. Vascular system ; Cardiovascular ; Cause of Death - trends ; Disease Progression ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Electrocardiography ; Endovascular Procedures - methods ; Female ; Follow-Up Studies ; Germany - epidemiology ; Heart ; Heart attacks ; Humans ; Incidence ; Internal Medicine ; Male ; Medical sciences ; Mortality ; Orthopedic surgery ; peripheral arterial disease ; Peripheral Arterial Disease - blood ; Peripheral Arterial Disease - epidemiology ; Peripheral Arterial Disease - surgery ; Prognosis ; Retrospective Studies ; Risk Assessment - methods ; Risk Factors ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Survival Rate - trends ; troponin T ; Troponin T - blood</subject><ispartof>Journal of the American College of Cardiology, 2014-04, Vol.63 (15), p.1529-1538</ispartof><rights>American College of Cardiology Foundation</rights><rights>2014 American College of Cardiology Foundation</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Apr 22, 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c513t-c0dec0cd34cc2b9fb1e4c97c94a26f4ce14eb3703af481912715c462333ab3033</citedby><cites>FETCH-LOGICAL-c513t-c0dec0cd34cc2b9fb1e4c97c94a26f4ce14eb3703af481912715c462333ab3033</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jacc.2013.05.059$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28438087$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23792625$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Linnemann, Birgit, MD</creatorcontrib><creatorcontrib>Sutter, Thilo</creatorcontrib><creatorcontrib>Herrmann, Eva, MD</creatorcontrib><creatorcontrib>Sixt, Sebastian, MD</creatorcontrib><creatorcontrib>Rastan, Aljoscha, MD</creatorcontrib><creatorcontrib>Schwarzwaelder, Uwe, MD</creatorcontrib><creatorcontrib>Noory, Elias, MD</creatorcontrib><creatorcontrib>Buergelin, Karlheinz, MD</creatorcontrib><creatorcontrib>Beschorner, Ulrich, MD</creatorcontrib><creatorcontrib>Zeller, Thomas, MD</creatorcontrib><title>Elevated Cardiac Troponin T Is Associated With Higher Mortality and Amputation Rates in Patients With Peripheral Arterial Disease</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>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 )</description><subject>Aged</subject><subject>Amputation</subject><subject>Amputation - trends</subject><subject>Angina pectoris</subject><subject>Ankle Brachial Index</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiology</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular</subject><subject>Cause of Death - trends</subject><subject>Disease Progression</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Electrocardiography</subject><subject>Endovascular Procedures - methods</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Germany - epidemiology</subject><subject>Heart</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Incidence</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Mortality</subject><subject>Orthopedic surgery</subject><subject>peripheral arterial disease</subject><subject>Peripheral Arterial Disease - blood</subject><subject>Peripheral Arterial Disease - epidemiology</subject><subject>Peripheral Arterial Disease - surgery</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Risk Assessment - methods</subject><subject>Risk Factors</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Survival Rate - trends</subject><subject>troponin T</subject><subject>Troponin T - blood</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kt9rFDEQx4Mo9nr6D_ggARF8uTPJ7E-QwnFWW6hY9MTHkJ2dtTn3dtckW7jH_udmvdNCH4RAMvD5TmbmO4y9kGIphczebpdbg7hUQsJSpPGUj9hMpmmxgLTMH7OZyCFdSFHmJ-zU-60QIitk-ZSdKMhLlal0xu7OW7o1gWq-Nq62BvnG9UPf2Y5v-KXnK-97tH-A7zbc8Av744Yc_9S7YFob9tx0NV_thjGYYPuOf4mo51F9HWPqgj_IrsnZIQpNy1cuxCA-3ltPxtMz9qQxrafnx3vOvn0436wvFlefP16uV1cLTCWEBYqaUGANCaKqyqaSlGCZY5kYlTUJkkyoglyAaZLYpFS5TDHJFACYCgTAnL055B1c_2skH_TOeqS2NR31o9cylXlRSBklc_bqAbrtR9fF6iKV5AClKKaE6kCh67131OjB2Z1xey2FngzSWz0ZpCeDtEjjKaPo5TH1WO2o_if560gEXh8B49G0jTMdWn_PFQkUosgj9-7AUZzZrSWnPcaBI9XWEQZd9_b_dZw9kGNrOxt__El78vf9aq-00F-nVZo2SYJQkIGC3yvqwwM</recordid><startdate>20140422</startdate><enddate>20140422</enddate><creator>Linnemann, Birgit, MD</creator><creator>Sutter, Thilo</creator><creator>Herrmann, Eva, MD</creator><creator>Sixt, Sebastian, MD</creator><creator>Rastan, Aljoscha, MD</creator><creator>Schwarzwaelder, Uwe, MD</creator><creator>Noory, Elias, MD</creator><creator>Buergelin, Karlheinz, MD</creator><creator>Beschorner, Ulrich, MD</creator><creator>Zeller, Thomas, MD</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20140422</creationdate><title>Elevated Cardiac Troponin T Is Associated With Higher Mortality and Amputation Rates in Patients With Peripheral Arterial Disease</title><author>Linnemann, Birgit, MD ; Sutter, Thilo ; Herrmann, Eva, MD ; Sixt, Sebastian, MD ; Rastan, Aljoscha, MD ; Schwarzwaelder, Uwe, MD ; Noory, Elias, MD ; Buergelin, Karlheinz, MD ; Beschorner, Ulrich, MD ; Zeller, Thomas, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c513t-c0dec0cd34cc2b9fb1e4c97c94a26f4ce14eb3703af481912715c462333ab3033</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Amputation</topic><topic>Amputation - trends</topic><topic>Angina pectoris</topic><topic>Ankle Brachial Index</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiology</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular</topic><topic>Cause of Death - trends</topic><topic>Disease Progression</topic><topic>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</topic><topic>Electrocardiography</topic><topic>Endovascular Procedures - methods</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Germany - epidemiology</topic><topic>Heart</topic><topic>Heart attacks</topic><topic>Humans</topic><topic>Incidence</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Mortality</topic><topic>Orthopedic surgery</topic><topic>peripheral arterial disease</topic><topic>Peripheral Arterial Disease - blood</topic><topic>Peripheral Arterial Disease - epidemiology</topic><topic>Peripheral Arterial Disease - surgery</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Risk Assessment - methods</topic><topic>Risk Factors</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Survival Rate - trends</topic><topic>troponin T</topic><topic>Troponin T - blood</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Linnemann, Birgit, MD</creatorcontrib><creatorcontrib>Sutter, Thilo</creatorcontrib><creatorcontrib>Herrmann, Eva, MD</creatorcontrib><creatorcontrib>Sixt, Sebastian, MD</creatorcontrib><creatorcontrib>Rastan, Aljoscha, MD</creatorcontrib><creatorcontrib>Schwarzwaelder, Uwe, MD</creatorcontrib><creatorcontrib>Noory, Elias, MD</creatorcontrib><creatorcontrib>Buergelin, Karlheinz, MD</creatorcontrib><creatorcontrib>Beschorner, Ulrich, MD</creatorcontrib><creatorcontrib>Zeller, Thomas, MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Linnemann, Birgit, MD</au><au>Sutter, Thilo</au><au>Herrmann, Eva, MD</au><au>Sixt, Sebastian, MD</au><au>Rastan, Aljoscha, MD</au><au>Schwarzwaelder, Uwe, MD</au><au>Noory, Elias, MD</au><au>Buergelin, Karlheinz, MD</au><au>Beschorner, Ulrich, MD</au><au>Zeller, Thomas, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Elevated Cardiac Troponin T Is Associated With Higher Mortality and Amputation Rates in Patients With Peripheral Arterial Disease</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>2014-04-22</date><risdate>2014</risdate><volume>63</volume><issue>15</issue><spage>1529</spage><epage>1538</epage><pages>1529-1538</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><coden>JACCDI</coden><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 )</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>23792625</pmid><doi>10.1016/j.jacc.2013.05.059</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Amputation Amputation - trends Angina pectoris Ankle Brachial Index Biological and medical sciences Blood and lymphatic vessels Cardiology Cardiology. Vascular system Cardiovascular Cause of Death - trends Disease Progression Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Electrocardiography Endovascular Procedures - methods Female Follow-Up Studies Germany - epidemiology Heart Heart attacks Humans Incidence Internal Medicine Male Medical sciences Mortality Orthopedic surgery peripheral arterial disease Peripheral Arterial Disease - blood Peripheral Arterial Disease - epidemiology Peripheral Arterial Disease - surgery Prognosis Retrospective Studies Risk Assessment - methods Risk Factors Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Survival Rate - trends troponin T Troponin T - blood |
| title | Elevated Cardiac Troponin T Is Associated With Higher Mortality and Amputation Rates in Patients With Peripheral Arterial Disease |
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