High-Sensitivity Cardiac Troponin Predicts Major Cardiovascular Events in Diabetic Patients With Critical Limb Ischemia and Foot Lesions

Abstract

Background: Diabetic patients with critical limb ischemia (CLI) and foot lesions show a poor prognosis. Optimal risk stratification to guide tailored intervention is still uncertain. The aim of the present study was to assess the prognostic role of high-sensitivity cardiac troponin T (hs-TnT) in such a high-risk population.Methods and Results: Clinical, laboratory, and interventional data, as well as the SPINACH score, were collected. Hs-TnT was measured at hospital admission. All patients were followed up for at least 1 year. The primary endpoint was the cumulative occurrence of major cardiovascular events (MACEs, all-cause death, myocardial infarction, or stroke). The secondary endpoint was all-cause mortality. Overall, 618 patients were included and followed for a median of 981 (557–1,325) days. Diagnosis of coronary artery disease (CAD) was established in 270 (43.7%) patients. Median hs-TnT at admission was 31 (20–59) ng/L, with 525 (85%) patients over the upper reference limit. Hs-TnT values were significantly higher in patients with established CAD (39 vs. 29 ng/L, p < 0.01). Hs-TnT was an independent predictor of MACE (HR 2.440, 95% CI 1.706–3.489, p < 0.001). The best cut-offs were 40 ng/L (AUC 0.711) for patients with established CAD and 25 ng/L (AUC 0.725) for those without. Hs-TnT emerged also as an independent predictor of all-cause mortality. The addition of hs-TnT improved prognostic value of the SPINACH score.Conclusions: Hs-TnT is a powerful biomarker for prognostic stratification of diabetic CLI patients with foot lesions. This is confirmed independently to CAD diagnosis and permits the identification of higher risk patients requiring tailored intervention.

Cardiac troponins predict mortality and cardiovascular outcomes in patients with peripheral artery disease: A systematic review and meta‐analysis of adjusted observational studies

“…After reading titles and abstracts, followed by a review of potentially relevant studies, eight studies were included in the final analysis, including a total of 5313 patients (Figure 1 ). 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 Seven studies were prospective, 10 , 11 , 12 , 13 , 15 , 16 , 17 and one was retrospective. 14 The study characteristics are listed in Table 1 .…”

“…Three studies 10 , 11 , 17 investigated outcomes exclusively in patients with CLI including 1006 patients. Meta‐analyses showed a significant association between elevated troponin levels and all‐cause mortality (HR: 2.84, 95% CI: 1.94–4.14; I 2 = 0.00%) and MACE (HR: 2.52, 95% CI: 1.83–3.48; I 2 = 0.00%) with low heterogeneity between studies.…”

“…Also, in five out of eight studies recent acute coronary syndrome before enrollment or other acute cardiac diseases that may cause an increase of cardiac troponins were clearly indicated as exclusion criteria. 11 , 13 , 14 , 16 , 17 In addition, risk of bias was evaluated for each study according to ROBINS‐I tool that included bias due to confounding. Two studies included in our systematic review reported receiver operating characteristic analysis for optimal cardiac troponin cutoff values in predicting adverse outcomes.…”

“…Two studies included in our systematic review reported receiver operating characteristic analysis for optimal cardiac troponin cutoff values in predicting adverse outcomes. In a study of patients with CLI Cimaglia et al 17 reported cardiac troponin cutoff of >40 ng/L for the prediction of MACE and >42 ng/L for all‐cause mortality. Clemens et al 15 in a population of claudicants identified the optimal troponin cutoff value of 9 ng/L for the prediction of mortality.…”

“…The data that support the findings of this study are openly available in (MEDLINE/PubMed) at https://www.ncbi.nlm.nih.gov/pmc/ , references. 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 …”