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

Vrsalović, Mislav; Presečki, Ana Vrsalović; Aboyans, Victor

doi:10.1002/clc.23776

Cited by 11 publications

(3 citation statements)

References 28 publications

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“…Cox regression was used to investigate unadjusted and adjusted significant associations between positive troponin concentrations and primary and secondary outcomes, which were expressed as hazard ratios with 95% confidence intervals (95% CI). To adjust models, we used age and sex and other known confounding factors for troponin elevation according to the literature (diabetes, hypertension, previous ischemic heart disease, previous peripheral vascular disease and renal failure -measured through estimated glomerular filtration rate) [12,13] if they were differently distributed between the two groups (patients with positive and negative troponin values) in the univariate analysis. In addition, interaction by sex was measured in all outcomes.…”

Section: Discussionmentioning

confidence: 99%

Association between troponin and outcome in patients with chest pain and rapid atrial fibrillation: a retrospective study of a single-center 10-year cohort

García

Miota

Miró

et al. 2022

European Journal of Emergency Medicine

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Background and objectiveThe prognosis of myocardial infarction in patients with rapid atrial fibrillation (RAF) is poorly known. We sought to ascertain if troponin concentrations are associated with a higher risk of major adverse cardiovascular events (MACE) in patients with RAF and chest discomfort suggestive of coronary origin. MethodsWe retrospectively reviewed all consecutive patients attending an emergency department of a single-center (2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017) with chest pain suggestive of coronary origin who had RAF and at least one troponin determination. Patients were classified as having normal/ increased troponin. They were followed until December 2019 to detect MACE (primary outcome), which included acute coronary syndrome (ACS), revascularization, stroke, or all-cause death. In addition to cardiovascular death and type I myocardial infarction, these were considered secondary outcomes. The adjusted risk was determined by Cox regression, and sensitivity analysis were run. Relationship between troponin as a continuous variable and outcomes was also evaluated, as well as interaction by sex. ResultsWe included 574 patients (median = 76.5 years, IQR = 14, women 56.8%, increased troponin 34.1%) followed by a median of 3.8 years (IQR = 4.8). MACE occurred in 200 patients (34.8%). Increased troponin was independently associated with MACE (adjusted hazard ratio, 1.502, 95% CI, 1.130-1.998), ACS (adjusted hazard ratio, 2.488, 95% CI, 1.256-4.928), type I myocardial infarction (adjusted hazard ratio, 2.771, 95% CI, 1.212-6.333) and stroke (adjusted hazard ratio, 3.580, 95% CI, 1.888-6.787) but not with death, cardiovascular death or revascularization. Sensitivity analyses were consistent with these results. There was no interaction by sex. When assessed continuously, an increase in troponin concentrations was lineally associated with a steady increase in the risk of MACE. ConclusionsIn patients with RAF who complain of chest pain, increased troponin levels are related to adverse cardiovascular outcomes.

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Section: Discussionmentioning

confidence: 99%

Association between troponin and outcome in patients with chest pain and rapid atrial fibrillation: a retrospective study of a single-center 10-year cohort

García

Miota

Miró

et al. 2022

European Journal of Emergency Medicine

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“…According to the results of this study, elevated troponin concentration was observed in 5.3% (range: 4.4%–8.7%) of patients with intermittent claudication and in 62.6% (range: 33.6%–85%) of patients with CLTI. An elevated troponin level was significantly associated with an increased risk of all-cause mortality (HR: 2.85, 95% CI: 2.28–3.57) and risk of major adverse cardiovascular events (HR: 2.58, 95% CI: 2.04–3.26) [ 101 ].…”

Section: Cardiac Troponin Serum Level In Chronic Cardiovascular Diseasesmentioning

confidence: 99%

Cardiac Troponin Serum Concentration Measurement Is Useful Not Only in the Diagnosis of Acute Cardiovascular Events

Jakubiak

2024

JPM

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Cardiac troponin serum concentration is the primary marker used for the diagnosis of acute coronary syndrome. Moreover, the measurement of cardiac troponin concentration is important for risk stratification in patients with pulmonary embolism. The cardiac troponin level is also a general marker of myocardial damage, regardless of etiology. The purpose of this study is to conduct a literature review and present the most important information regarding the current state of knowledge on the cardiac troponin serum concentration in patients with chronic cardiovascular disease (CVD), as well as on the relationships between cardiac troponin serum concentration and features of subclinical cardiovascular dysfunction. According to research conducted to date, patients with CVDs, such as chronic coronary syndrome, chronic lower extremities’ ischemia, and cerebrovascular disease, are characterized by higher cardiac troponin concentrations than people without a CVD. Moreover, the literature data indicate that the concentration of cardiac troponin is correlated with markers of subclinical dysfunction of the cardiovascular system, such as the intima–media thickness, pulse wave velocity, ankle–brachial index, coronary artery calcium index (the Agatston score), and flow-mediated dilation. However, further research is needed in various patient subpopulations and in different clinical contexts.

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“…Individuals diagnosed with PAD not only face limb-related problems but also have an increased risk of cardiovascular events, including myocardial infarction (MI), stroke, and cardiovascular-related mortality. 1,4,5 In recent years, there has been a paradigm shift in the treatment of hypertension, with an emphasis on intensive blood pressure (BP) control. Clinical trials have shown that aggressive reduction of BP in certain populations can significantly reduce the risk of cardiovascular events, including MI, stroke, and heart failure (HF).…”

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confidence: 99%

Cardiovascular Outcomes in Hypertension-Treated Patients With Peripheral Artery Disease: The VALUE Trial

Vrsalovic,

Heimark,

Søraas

et al. 2024

Hypertension

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BACKGROUND: Systolic blood pressure (BP) is a key predictor of cardiovascular events, but patients with peripheral artery disease (PAD) are rarely included in hypertension trials. The VALUE trial (Valsartan Antihypertensive Long-Term Use Evaluation) investigated the long-term effects of valsartan- or amlodipine-based treatments on cardiovascular outcomes in patients with hypertension with a high cardiovascular risk. The aim of this subanalysis was to clarify the relationship between achieved BP on treatment and cardiovascular outcomes in patients with hypertension with PAD. METHODS: Patients were followed for 4 to 6 years, and BP was measured regularly. The primary end point was time to the first major adverse cardiovascular event, including myocardial infarction, stroke, cardiovascular death, and heart failure requiring hospitalization. Statistical analyses were performed using Cox regression, adjusting for various baseline covariates. RESULTS: Of the 13 803 participants, 1898 (13.8%) had PAD. During a median follow-up of 4.5 years, patients with PAD had a 23% increased risk of major adverse cardiovascular events compared with patients without PAD. Patients with an achieved systolic BP <130 mm Hg and 130 to 139 mm Hg, compared with those with systolic BP ≥140 mm Hg, were associated with a decreased risk of a major adverse cardiovascular event (hazard ratio, 0.65 [95% CI, 0.43–0.97]; P =0.037; 0.85 [95% CI, 0.74–0.97]; P =0.016, respectively). Additionally, systolic BP <130 mm Hg was associated with a decreased risk of cardiovascular death (hazard ratio, 0.33 [95% CI, 0.12–0.92]; P =0.034). The incidence of the primary outcome did not differ between antihypertensive treatment regimens ( P =0.365). CONCLUSIONS: Our results indicate that more intensive BP control is associated with a reduction in cardiovascular morbidity and mortality in patients with hypertensive PAD.

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

Cited by 11 publications

References 28 publications

Association between troponin and outcome in patients with chest pain and rapid atrial fibrillation: a retrospective study of a single-center 10-year cohort

Association between troponin and outcome in patients with chest pain and rapid atrial fibrillation: a retrospective study of a single-center 10-year cohort

Cardiac Troponin Serum Concentration Measurement Is Useful Not Only in the Diagnosis of Acute Cardiovascular Events

Cardiovascular Outcomes in Hypertension-Treated Patients With Peripheral Artery Disease: The VALUE Trial

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