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Tedla YG, Driver S, Szklo M, Kuller L, Lima JA, Michos ED, Ning H, deFilippi CR, Greenland P. Joint effect of highly-sensitive cardiac troponin T and ankle-brachial index on incident cardiovascular events: The MESA and CHS. Am J Prev Cardiol 2023; 13:100471. [PMID: 36873803 PMCID: PMC9975219 DOI: 10.1016/j.ajpc.2023.100471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/17/2022] [Accepted: 02/03/2023] [Indexed: 02/13/2023] Open
Abstract
Background Elevated highly-sensitive cardiac troponin-T (hs-cTnT≥14 ng/L) and low ankle-brachial index (ABI<0.9) are risk factors for atherosclerotic cardiovascular diseases (ASCVD) but their joint effect on the risk of ASCVD events is unknown. Methods We used data from the two population-based cohort studies, the Multi-Ethnic study of Atherosclerosis (MESA) and Cardiovascular Heart Study (CHS) among 10,897 participants free of CVD events at baseline (mean age 66.3 years, 44.7% males). Incident ASCVD was defined as CHD (fatal/non-fatal MI or revascularization), transient ischemic attack, or stroke,. Hazard ratio (HR) and 95% CI was calculated from a Cox regression model. Interaction on the additive scale was assessed using relative excess risk due to interaction (RERI) and interaction on the multiplicative scale was assessed by Likelihood ratio (LR) test. Results At baseline (2000-2002 for MESA and 1989-1990 for CHS), 10.2% of participants had elevated hs-cTnT and 7.5% had low ABI. During a median follow-up of 13.6 years (interquartile range, 7.5-14.7 years), there were 2590 incident ASCVD and 1542 incident CHD events. The hazard of CHD and ASCVD was higher in participants with both elevated hs-cTnT and low ABI [HR(95% CI): CHD: 2.04 (1.45, 2.88), ASCVD: 2.05 (1.58, 2.66)] than those with only elevated hs-cTnT [CHD: 1.65 (1.37, 1.99), ASCVD: 1.67 (1.44, 1.99)] or only low ABI [CHD: 1.87 (1.52, 2.31), ASCVD: 1.67 (1.42, 1.97)]. Antagonistic multiplicative interaction was observed for CHD (LR test p-value=0.042) but not for ASCVD (LR test p-value =0.08). No significant additive interaction was detected for CHD and ASCVD (RERI p-value ≥0.23). Conclusion The observed joint effect of elevated cTnT and low ABI on ASCVD risk was smaller (i.e., antagonistic interaction) than that expected by the combined independent effects of each risk factor.
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Affiliation(s)
- Yacob G Tedla
- Vanderbilt University Medical Center, Department of Medicine, Division of Epidemiology, Nashville, TN, United States
| | - Steven Driver
- Advocate Aurora Health, Advocate Heart Institute, Chicago, IL, United States
| | - Moyses Szklo
- Johns Hopkins University Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, United States
| | - Lewis Kuller
- University of Pittsburgh, School of Public Health, Department of Epidemiology, Pittsburgh, PA, United States
| | - Joao Ac Lima
- Johns Hopkins University, School of Medicine, Department of Medicine, Baltimore, MD, United States
| | - Erin D Michos
- Johns Hopkins University, School of Medicine, Department of Medicine, Baltimore, MD, United States
| | - Hongyan Ning
- Northwestern University Feinberg School of Medicine, Department of Preventive Medicine, Chicago, IL, United States
| | | | - Philip Greenland
- Northwestern University Feinberg School of Medicine, Department of Preventive Medicine, Chicago, IL, United States
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Tsujimura T, Takahara M, Iida O, Kohsaka S, Soga Y, Fujihara M, Mano T, Ohya M, Shinke T, Amano T, Ikari Y. In-Hospital Outcomes after Endovascular Therapy for Acute Limb Ischemia: A Report from a Japanese Nationwide Registry [J-EVT Registry]. J Atheroscler Thromb 2021; 28:1145-1152. [PMID: 33229856 PMCID: PMC8592702 DOI: 10.5551/jat.60053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Aim:
The aim of the current study was to describe the clinical profile, frequency of in-hospital complications, and predictors of adverse events in patients undergoing endovascular therapy (EVT) for acute limb ischemia (ALI), and to compare them with those of patients undergoing EVT for chronic symptomatic peripheral artery disease (PAD).
Methods:
The current study compared 2,398 cases of EVT for ALI with 74,171 cases of EVT for chronic symptomatic PAD performed between January 2015 and December 2018 in Japan. We first compared the clinical profiles of ALI patients with those of PAD patients. We then evaluated the proportion of in-hospital complications and investigated their risk factors in the ALI patients. The association of clinical characteristics with the risk of in-hospital complications was analyzed via logistic regression modeling.
Results:
Patients with ALI were older and had a higher prevalence of female sex, impaired mobility, and history of cerebrovascular disease, but a lower prevalence of cardiovascular risk factors and history of coronary artery disease. The proportion of in-hospital EVT-related complications in ALI was 6.1% and was significantly higher compared with those in chronic symptomatic PAD patients (2.0%,
P
<0.001). Bedridden status (adjusted odds ratio [aOR], 1.74 [1.14 to 2.66];
P
=0.010), history of coronary artery disease (aOR, 1.80 [1.21 to 2.68];
P
=0.004), and a suprapopliteal lesion (aOR, 1.70 [1.05 to 2.74];
P
=0.030) were identified as independent risk factors for in-hospital complications.
Conclusion:
The current study demonstrated that ALI patients with significant comorbidities show a higher proportion of in-hospital complications after EVT.
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Affiliation(s)
| | - Mitsuyoshi Takahara
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine.,Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | | | | | | | - Masanobu Ohya
- Department of Cardiology, Kurashiki Central Hospital
| | - Toshiro Shinke
- Department of Cardiology, Showa University School of Medicine
| | | | - Yuji Ikari
- Division of Cardiovascular Medicine, Tokai University Hospital
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3
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Risk stratification and mortality prediction in octo- and nonagenarians with peripheral artery disease: a retrospective analysis. BMC Cardiovasc Disord 2021; 21:370. [PMID: 34340657 PMCID: PMC8330051 DOI: 10.1186/s12872-021-02177-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 07/20/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives Among changes in demographics, aging is the most relevant cardiovascular risk factor. The prevalence of peripheral artery disease (PAD) is high in elderly patients and is associated with a worse prognosis. Despite optimal treatments, mortality in the high-risk population of octo- and nonagenarians with PAD remains excessive, and predictive factors need to be identified. The objective of this study was to investigate predictors of mortality in octo- and nonagenarians with PAD. Methods Cases of treated octo- and nonagenarians, including the clinical characteristics and markers of myocardial injury and heart failure, were studied retrospectively with respect to all-cause mortality. Hazard ratios [HR] were calculated and survival was analyzed by Kaplan-Meyer curves and receiver operating characteristic curved were assessed for troponin-ultra and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and chronic limb-threatening ischemia (CLTI). Results A total of 123 octo- and nonagenarians admitted for PAD were eligible. The troponin level was the major predictor of all-cause mortality (HR: 4.6, 95% confidence interval [CI]: 1.4–15.3), followed by the NT-proBNP level (HR: 3.9, 95% CI 1.8–8.8) and CLTI (HR: 3.1, 95% CI 1.6–5.9). Multivariate regression revealed that each increment of 1 standard deviation in log troponin and log NT-proBNP was associated with a 2.7-fold (95% CI 1.8–4.1) and a 1.9-fold (95% CI 1.2–2.9) increased risk of all-cause death. Receiver operating characteristic curve analysis using a combination of all predictors yielded an improved area under the curve of 0.888. In a control group of an equal number of younger individuals, only NT-proBNP (HR: 4.2, 95% CI 1.2–14.1) and CLTI (HR: 6.1, 95% CI 1.6–23.4) were predictive of mortality. Conclusion Our study demonstrates that cardiovascular biomarkers and CLTI are the primary predictors of increased mortality in elderly PAD patients. Further risk stratification through biomarkers in this high-risk population of octo- and nonagenarians with PAD is necessary. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02177-1.
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Saenz-Pipaon G, Martinez-Aguilar E, Orbe J, González Miqueo A, Fernandez-Alonso L, Paramo JA, Roncal C. The Role of Circulating Biomarkers in Peripheral Arterial Disease. Int J Mol Sci 2021; 22:ijms22073601. [PMID: 33808453 PMCID: PMC8036489 DOI: 10.3390/ijms22073601] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 12/18/2022] Open
Abstract
Peripheral arterial disease (PAD) of the lower extremities is a chronic illness predominantly of atherosclerotic aetiology, associated to traditional cardiovascular (CV) risk factors. It is one of the most prevalent CV conditions worldwide in subjects >65 years, estimated to increase greatly with the aging of the population, becoming a severe socioeconomic problem in the future. The narrowing and thrombotic occlusion of the lower limb arteries impairs the walking function as the disease progresses, increasing the risk of CV events (myocardial infarction and stroke), amputation and death. Despite its poor prognosis, PAD patients are scarcely identified until the disease is advanced, highlighting the need for reliable biomarkers for PAD patient stratification, that might also contribute to define more personalized medical treatments. In this review, we will discuss the usefulness of inflammatory molecules, matrix metalloproteinases (MMPs), and cardiac damage markers, as well as novel components of the liquid biopsy, extracellular vesicles (EVs), and non-coding RNAs for lower limb PAD identification, stratification, and outcome assessment. We will also explore the potential of machine learning methods to build prediction models to refine PAD assessment. In this line, the usefulness of multimarker approaches to evaluate this complex multifactorial disease will be also discussed.
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Affiliation(s)
- Goren Saenz-Pipaon
- Laboratory of Atherothrombosis, Program of Cardiovascular Diseases, Cima Universidad de Navarra, 31008 Pamplona, Spain; (G.S.-P.); (J.O.); (J.A.P.)
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain; (E.M.-A.); (A.G.M.); (L.F.-A.)
| | - Esther Martinez-Aguilar
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain; (E.M.-A.); (A.G.M.); (L.F.-A.)
- Departamento de Angiología y Cirugía Vascular, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain
| | - Josune Orbe
- Laboratory of Atherothrombosis, Program of Cardiovascular Diseases, Cima Universidad de Navarra, 31008 Pamplona, Spain; (G.S.-P.); (J.O.); (J.A.P.)
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain; (E.M.-A.); (A.G.M.); (L.F.-A.)
- CIBERCV, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Arantxa González Miqueo
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain; (E.M.-A.); (A.G.M.); (L.F.-A.)
- CIBERCV, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Laboratory of Heart Failure, Program of Cardiovascular Diseases, Cima Universidad de Navarra, 31008 Pamplona, Spain
| | - Leopoldo Fernandez-Alonso
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain; (E.M.-A.); (A.G.M.); (L.F.-A.)
- Departamento de Angiología y Cirugía Vascular, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain
| | - Jose Antonio Paramo
- Laboratory of Atherothrombosis, Program of Cardiovascular Diseases, Cima Universidad de Navarra, 31008 Pamplona, Spain; (G.S.-P.); (J.O.); (J.A.P.)
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain; (E.M.-A.); (A.G.M.); (L.F.-A.)
- CIBERCV, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Hematology Service, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Carmen Roncal
- Laboratory of Atherothrombosis, Program of Cardiovascular Diseases, Cima Universidad de Navarra, 31008 Pamplona, Spain; (G.S.-P.); (J.O.); (J.A.P.)
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain; (E.M.-A.); (A.G.M.); (L.F.-A.)
- CIBERCV, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-948194700
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Pereira-Macedo J, Machado N, Pereira-Neves A, Ferreira V, Oliveira-Pinto J, Dias-Neto M, Rocha-Neves J, Teixeira J, Andrade J. Myocardial injury after aortoiliac revascularization for extensive disease: A survival analysis. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2020; 28:426-434. [PMID: 32953204 PMCID: PMC7493606 DOI: 10.5606/tgkdc.dergisi.2020.20100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/23/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND This study aims to evaluate the incidence of myocardial injury after non-cardiac surgery for an extensive disease pattern (TASC II type D) and to examine its prognostic value. METHODS This prospective study included a total of 66 consecutive patients (62 males, 4 females; mean age 62.5±8.2 years) who underwent elective revascularization for aortoiliac TASC II type D lesions in the tertiary setting between January 2013 and March 2019. The patients were scheduled for revascularization either by open surgery or endovascular approach. Cardiac troponins were routinely measured in the postoperative period. Myocardial injury after non-cardiac surgery was defined as the elevation of cardiac troponin for at least one value above the 99th percentile upper reference limit. Myocardial infarction, acute heart failure, stroke, major adverse cardiovascular events, major adverse limb events, and all-cause mortality were assessed both postoperatively and during follow-up. RESULTS The incidence of myocardial injury after non-cardiac surgery was 25.8%. In the multivariate analysis, chronic heart failure was found to be a significant risk factor for myocardial injury after non-cardiac surgery (odds ratio: 10.3; 95% confidence interval 1.00-106.8, p=0.018). At 12 months after revascularization, the diagnosis of myocardial injury after non-cardiac surgery was significantly associated with myocardial infarction, stroke, major adverse cardiovascular events, major adverse limb events, and all-cause mortality. At 12 months after revascularization, the diagnosis of myocardial injury after non-cardiac surgery was significantly associated with myocardial infarction (log-rank p=0.002), stroke (log-rank p=0.007), major adverse cardiovascular events (log-rank p=0.000), major adverse limb events (log-rank p=0.007), and all-causemortality (log-rank p=0.000). CONCLUSION Our study results suggest that myocardial injury after non-cardiac surgery plays a role as a predictor of significant cardiovascular comorbidities and mortality after complex aortoiliac revascularization. The presence of chronic heart failure is also associated with a higher incidence of myocardial injury after aortoiliac TASC II type D revascularization. Therefore, preemptive strategies should be adopted to identify and treat these patients.
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Affiliation(s)
- Juliana Pereira-Macedo
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Neuza Machado
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - António Pereira-Neves
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Biomedicine - Unit of Anatomy, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Vítor Ferreira
- Department of Angiology and Vascular Surgery, Centro Hospitalar Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - José Oliveira-Pinto
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Marina Dias-Neto
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Rocha-Neves
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Biomedicine - Unit of Anatomy, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | - José Teixeira
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - José Andrade
- Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
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6
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Matsushita K, Kwak L, Yang C, Pang Y, Ballew SH, Sang Y, Hoogeveen RC, Jaar BG, Selvin E, Ballantyne CM, Sharrett AR, Folsom AR, Heiss G, Coresh J, Hirsch AT. High-sensitivity cardiac troponin and natriuretic peptide with risk of lower-extremity peripheral artery disease: the Atherosclerosis Risk in Communities (ARIC) Study. Eur Heart J 2018; 39:2412-2419. [PMID: 29579246 PMCID: PMC6031056 DOI: 10.1093/eurheartj/ehy106] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/30/2017] [Accepted: 03/13/2018] [Indexed: 01/08/2023] Open
Abstract
Aims Cardiac troponin T (cTnT) is suggested as a predictor of amputation in patients with peripheral artery disease (PAD). However, cTnT-PAD association has not been systematically studied in a large study. This study evaluated the association of high-sensitivity cTnT (hs-cTnT) with PAD incidence and also explored whether natriuretic peptide (NT-proBNP), another representative cardiac marker, predicts PAD risk. Methods and results Among 12 288 middle-aged adults, the associations of hs-cTnT and NT-proBNP with incident PAD (hospitalizations with PAD diagnosis or leg revascularization [cases with rest pain or tissue loss considered as critical limb ischaemia (CLI)]) were quantified with multivariable Cox regression models. The risk discrimination was assessed by c-statistic. During a follow-up over 22 years, 454 participants developed PAD (164 CLI cases). In demographically adjusted models, the highest category of hs-cTnT (≥14 vs. <3 ng/L) and NT-proBNP (≥258.3 vs. <51.5 pg/mL) showed ∼8- and 10-20-fold higher risk of PAD and CLI, respectively. Even after adjusting for potential confounders and each other, hazard ratios were greater for CLI than for PAD (7.74 95% confidence interval [95% CI 4.43-13.55] vs. 2.84 [2.02-4.00] for the highest vs. reference hs-cTnT category and 4.63 [2.61-8.23] vs. 3.16 [2.23-4.49] for the highest vs. reference NT-proBNP category). The addition of these cardiac markers improved c-statistics for CLI. Conclusion High-sensitivity cTnT and NT-proBNP were independently associated with incident PAD, particularly its severe form, CLI. Although future studies are warranted to investigate pathophysiological mechanisms behind these associations, our study suggests the usefulness of cardiac markers to identify individuals at high risk of CLI.
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Affiliation(s)
- Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, USA
| | - Lucia Kwak
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, USA
| | - Chao Yang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, USA
| | - Yuanjie Pang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, USA
| | - Shoshana H Ballew
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, USA
| | - Yingying Sang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, USA
| | - Ron C Hoogeveen
- Department of Medicine, Section of Atherosclerosis and Vascular Medicine, Baylor College of Medicine, 6565 Fannin Street, Houston, TX, USA
| | - Bernard G Jaar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, USA
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, 1830 East Monument St., Baltimore, MD, USA
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, USA
| | - Christie M Ballantyne
- Department of Medicine, Section of Atherosclerosis and Vascular Medicine, Baylor College of Medicine, 6565 Fannin Street, Houston, TX, USA
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, USA
| | - Aaron R Folsom
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, West Bank Office Building, 1300 South Second Street, Minneapolis, MN, USA
| | - Gerardo Heiss
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, 123 W. Franklin Street, Chapel Hill, NC, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Baltimore, MD, USA
| | - Alan T Hirsch
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, 1830 East Monument St., Baltimore, MD, USA
- University of Minnesota Medical School, Mayo Building, 420 Delaware Street SE, Minneapolis, MN, USA
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7
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Inagaki E, Farber A, Kalish JA, Eslami MH, Siracuse JJ, Eberhardt RT, Rybin DV, Doros G, Hamburg NM. Outcomes of Peripheral Vascular Interventions in Select Patients With Lower Extremity Acute Limb Ischemia. J Am Heart Assoc 2018; 7:JAHA.116.004782. [PMID: 29650705 PMCID: PMC6015405 DOI: 10.1161/jaha.116.004782] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Contemporary data on patients presenting with acute limb ischemia (ALI), who are selected for treatment with endovascular peripheral vascular interventions (PVI), are limited. Our study examined outcomes following endovascular PVI in patients with ALI by comparing with patients treated for chronic critical limb ischemia using a regional quality improvement registry. Methods and Results Of the 11 035 patients in the Vascular Study Group of New England PVI database (2010–2014), we identified 365 patients treated for lower extremity ALI who were 5:1 frequency matched (by procedure year and arterial segments treated) to 1808 patients treated for critical limb ischemia. ALI patients treated with PVI had high burden of atherosclerotic risk factors and were more likely to have had prior ipsilateral revascularizations. ALI patients were less likely to be treated with self‐expanding stents and more likely to undergo thrombolysis than patients with critical limb ischemia. In multivariable analysis, ALI was associated with higher technical failure (odds ratio 1.7, 95% confidence interval, 1.1%–2.5%), increased rate of distal embolization (odds ratio 2.7, 95% confidence interval, 1.5%–4.9%), longer length of stay (means ratio 1.6, 95% confidence interval, 1.4%–1.8%), and higher in‐hospital mortality (odds ratio 2.8, 95% confidence interval, 1.3%–5.9%). ALI was not associated with risk of major amputation or mortality at 1 year. Conclusions In a multicenter cohort of patients treated with PVI, we found that ALI patients selected for treatment with endovascular techniques experienced greater short‐term adverse events but similar long‐term outcomes as their critical limb ischemia counterparts. Further studies are needed to refine the selection of ALI patients who are best served by PVI.
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Affiliation(s)
- Elica Inagaki
- Department of Surgery, Boston Medical Center, Boston, MA
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Department of Surgery, Boston Medical Center, Boston, MA
| | - Jeffrey A Kalish
- Division of Vascular and Endovascular Surgery, Department of Surgery, Boston Medical Center, Boston, MA
| | - Mohammad H Eslami
- Division of Vascular and Endovascular Surgery, Department of Surgery, Boston Medical Center, Boston, MA
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Department of Surgery, Boston Medical Center, Boston, MA
| | - Robert T Eberhardt
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
| | - Denis V Rybin
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Gheorghe Doros
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Naomi M Hamburg
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
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9
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Patelis N, Kouvelos GN, Koutsoumpelis A, Moris D, Matsagkas MI, Arnaoutoglou E. An update on predictive biomarkers for major adverse cardiovascular events in patients undergoing vascular surgery. J Clin Anesth 2016; 33:105-16. [PMID: 27555142 DOI: 10.1016/j.jclinane.2016.03.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 09/27/2015] [Accepted: 03/05/2016] [Indexed: 10/21/2022]
Abstract
Cardiovascular complications signify a major cause of morbidity and mortality in patients undergoing vascular surgery adversely affecting both short- and long-term prognosis. During the last decade, unmet needs for a distinct cardiovascular risk assessment have led to an intensive research for establishment of biomarkers with sufficient predictive value. This literature review aims in examining the value of several biomarkers in predicting the incidence of major adverse cardiac events in vascular surgery patients. We reviewed the English language literature and analyzed the biomarkers as independent predictors or in correlation with other factors. We found several biomarkers showing a significant predictive value for a major adverse cardiovascular event in patients undergoing vascular surgery. These biomarkers can be used in clinical practice as outcome predictors, although sensitivity and specificity varies. Detection of subclinical cardiovascular damage may improve total risk estimation and facilitate clinical assessment of patients at risk for future cardiovascular events. The wide variety of sensitivity and specificity in predicting a MACE of these biomarkers exert the need for future trials in which these markers will be tested as adjunctive tools of cardiovascular risk estimation scoring systems.
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Affiliation(s)
- Nikolaos Patelis
- First Department of Surgery, Vascular Surgery Division, National & Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.
| | - George N Kouvelos
- Department of Surgery, Vascular Surgery Unit, Medical School, University of Ioannina, Ioannina, Greece
| | - Andreas Koutsoumpelis
- First Department of Surgery, Vascular Surgery Division, National & Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Demetrios Moris
- First Department of Surgery, National & Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Miltiadis I Matsagkas
- Department of Surgery, Vascular Surgery Unit, Medical School, University of Ioannina, Ioannina, Greece
| | - Eleni Arnaoutoglou
- Department of Anesthesiology, Medical School, University of Ioannina, Ioannina, Greece
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High-sensitivity cardiac troponin T in patients with intermittent claudication and its relation with cardiovascular events and all-cause mortality--the CAVASIC Study. Atherosclerosis 2014; 237:711-7. [PMID: 25463110 DOI: 10.1016/j.atherosclerosis.2014.10.097] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 09/30/2014] [Accepted: 10/15/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Serum concentrations of high-sensitivity cardiac troponin T (hs-cTnT) are elevated in various diseases. The role of this marker in peripheral arterial disease (PAD) has not been fully investigated. METHODS Hs-cTnT was measured in the CAVASIC Study, a male cohort of 235 patients diagnosed with intermittent claudication and 249 age- and diabetes-matched controls. Patients with symptomatic PAD were prospectively followed for a median time of 7 years. The association of hs-cTnT with PAD, cardiovascular disease (CVD) at baseline as well as incident CVD and all-cause mortality during follow-up was analyzed. RESULTS Detectable hs-cTnT was associated with an 84% higher probability for symptomatic PAD at baseline: OR = 1.84, 95%CI 1.05-3.21, p = 0.03. Inclusion of ln-NT-proBNP or prevalent CVD abolished this association (both OR = 1.22, p = 0.52). However, detectable hs-cTnT was associated with prevalent CVD (n = 69) in PAD patients independent from ln-NT-proBNP: OR = 3.42, p = 0.001. In the adjusted Cox regression analysis detectable (HR = 2.15, p = 0.05) and especially hs-cTnT ≥ 14 ng/L (HR = 5.06, p < 0.001) were predictive for all-cause mortality (n = 39) independent from ln-NT-proBNP. Furthermore, hs-cTnT ≥ 14 ng/L was significantly associated with incident CVD (n = 66): HR = 3.15, 95%CI 1.26-7.89, p = 0.01. CONCLUSIONS This study in male patients with intermittent claudication and age- and diabetes-matched controls revealed hs-cTnT to be associated with PAD and prevalent CVD. The latter association was even significant after considering NT-proBNP. Prospectively, in PAD patients hs-cTnT was predictive for incident cardiovascular diseases and all-cause mortality. Thus, hs-cTnT could be a surrogate marker for cardiomyocyte damage also in symptomatic PAD patients.
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Linnemann B, Sutter T, Herrmann E, Sixt S, Rastan A, Schwarzwaelder U, Noory E, Buergelin K, Beschorner U, Zeller T. Elevated Cardiac Troponin T Is Associated With Higher Mortality and Amputation Rates in Patients With Peripheral Arterial Disease. J Am Coll Cardiol 2014; 63:1529-38. [DOI: 10.1016/j.jacc.2013.05.059] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 04/18/2013] [Accepted: 05/05/2013] [Indexed: 10/26/2022]
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de Lemos JA, Kumbhani DJ. Lessons from the heart: troponin elevations in patients with established peripheral artery disease. J Am Coll Cardiol 2013; 63:1539-41. [PMID: 23810876 DOI: 10.1016/j.jacc.2013.05.063] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 05/28/2013] [Indexed: 11/16/2022]
Affiliation(s)
- James A de Lemos
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Dharam J Kumbhani
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
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