title: Elevated cardiac troponin T contributes to prediction of worse in-hospital outcomes after endovascular therapy for acute limb ischemia.
abstract: BACKGROUND
  The present study evaluated whether elevated cardiac troponin T (cTnT) was predictive of an increased risk for death or amputation in patients with acute lower limb ischemia (ALI). ALI is one of the most frequent causes of amputation, with mortality rates for ALI ranging from 15% to 20%.
  
  
  METHODS
  This study included 254 consecutive ALI patients (155 men, 99 women; mean age, 71.6 ± 13.2 years) presenting with Rutherford categories I, IIA, or IIB according to the classification for ALI.
  
  
  RESULTS
  ALI was caused by thromboembolism (29.5%), local arterial thrombosis (53.1%), or bypass graft occlusion (16.9%). Restoration of arterial blood flow was obtained by an endovascular approach, with a primary success rate of 98.4%. Rates were low for in-hospital mortality (3.9%) and amputation (5.1%). Patients who died or required amputation more frequently presented with elevated cTnT ≥0.01 ng/mL (52.2% vs 25.5%, P = .01) and impaired renal function (chronic kidney disease stage 3-5; 60.9% vs 38.1%; P = .04). After controlling for age, sex, C-reactive protein, renal function, presence or absence of coronary artery disease, and traditional vascular risk factors, as well as the interval between symptom onset and revascularization, the relationship between cTnT and a worse in-hospital outcome remained significant (hazard ratio, 3.4; 95% confidence interval, 1.3-8.5; P = .010).
  
  
  CONCLUSIONS
  ALI patients frequently have elevated cTnT, which is associated with increased in-hospital mortality and amputation. Even small cTnT elevations predict a markedly increased risk of worse in-hospital outcome; however, the overall mortality and amputation rate in our study was low.
authors.affiliation: Department of Angiology, Heart Center Bad Krozingen, Bad Krozingen, Germany. birgit.linnemann@kgu.de
authors.forename: Birgit
authors.initials: B
authors.lastname: Linnemann
authors.forename: Thilo
authors.initials: T
authors.lastname: Sutter
authors.forename: Sebastian
authors.initials: S
authors.lastname: Sixt
authors.forename: Aljoscha
authors.initials: A
authors.lastname: Rastan
authors.forename: Uwe
authors.initials: U
authors.lastname: Schwarzwaelder
authors.forename: Elias
authors.initials: E
authors.lastname: Noory
authors.forename: Karlheinz
authors.initials: K
authors.lastname: Buergelin
authors.forename: Ulrich
authors.initials: U
authors.lastname: Beschorner
authors.forename: Thomas
authors.initials: T
authors.lastname: Zeller
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D007511:Ischemia / Q000097:blood / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood*; D015854:Up-Regulation; D055815:Young Adult
chemical_list: D015415:Biomarkers; D020107:Troponin T