title: Elevated cardiac troponin T is associated with higher mortality and amputation rates in patients with peripheral arterial disease.
abstract: OBJECTIVE
  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).
authors.affiliation: 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: Birgit.Linnemann@kgu.de.
authors.forename: Birgit
authors.initials: B
authors.lastname: Linnemann
authors.affiliation: Department of Angiology, University Heart Center Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Thilo
authors.initials: T
authors.lastname: Sutter
authors.affiliation: Institute of Biostatistics and Math, Modeling, Faculty of Medicine, Goethe University Hospital Frankfurt/Main, Frankfurt/Main, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Herrmann
authors.affiliation: Department of Angiology, University Heart Center Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Sixt
authors.affiliation: Department of Angiology, University Heart Center Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Aljoscha
authors.initials: A
authors.lastname: Rastan
authors.affiliation: Department of Angiology, University Heart Center Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Schwarzwaelder
authors.affiliation: Department of Angiology, University Heart Center Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Elias
authors.initials: E
authors.lastname: Noory
authors.affiliation: Department of Angiology, University Heart Center Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Karlheinz
authors.initials: K
authors.lastname: Buergelin
authors.affiliation: Department of Angiology, University Heart Center Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Beschorner
authors.affiliation: Department of Angiology, University Heart Center Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zeller
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000639:trends*; D055109:Ankle Brachial Index; D002423:Cause of Death / Q000639:trends; D018450:Disease Progression; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D058729:Peripheral Arterial Disease / Q000097:blood* / Q000453:epidemiology / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D020107:Troponin T / Q000097:blood*
chemical_list: D020107:Troponin T
keywords: amputation; mortality; peripheral arterial disease; troponin T