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Meta-Analysis
. 2022 Feb;45(2):198-204.
doi: 10.1002/clc.23776. Epub 2022 Feb 7.

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

Mislav Vrsalovic  1   2 , Ana Vrsalovic Presecki  3 , Victor Aboyans  4   5
Affiliations
Meta-Analysis

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

Mislav Vrsalovic et al. Clin Cardiol. 2022 Feb.

Abstract

Background: A significant proportion of patients (pts) with peripheral artery disease (PAD) have concomitant coronary artery disease and polyvascular involvement contributes to increased risk of death and unfavorable cardiovascular events.

Hypothesis: Cardiac troponins are associated with adverse cardiovascular outcomes in PAD pts.

Methods: We systematically searched Medline and Scopus to identify all observational cohort studies published before June 2021 (combining terms "troponin," "peripheral artery disease," "peripheral arterial disease," "intermittent claudication," and "critical limb ischemia") that evaluated the prognostic impact of troponin rise on admission on all-cause mortality and/or major cardiovascular events (MACEs; composite of myocardial infarction, stroke, and cardiovascular death) in PAD pts followed up at least 6 months. A meta-analysis was conducted using the generic inverse variance method. Heterogeneity between studies was investigated using Cochrane's Q test and I2 statistic.

Results: Eight studies were included in the final analysis (5313 pts) with a median follow-up of 27 months (interquartile range: 12-59 months). The prevalence of troponin positivity was 5.3% (range: 4.4%-8.7%) in pts with intermittent claudication, and 62.6% (range: 33.6%-85%) in critical limb ischemia. Elevated troponins were significantly associated with an increased risk of all-cause mortality (hazard ratio [HR]: 2.85, 95% confidence interval [CI]: 2.28-3.57; I2 = 50.97%), and MACE (HR: 2.58, 95% CI: 2.04-3.26; I2 = 4.00%) without publication bias (p = .24 and p = .10, respectively).

Conclusion: Troponin rise on admission is associated with adverse long-term cardiovascular outcomes in symptomatic PAD.

Keywords: critical limb ischemia; major cardiovascular events; meta-analysis; mortality; peripheral artery disease; troponin.

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Conflict of interest statement

The authors declare that there are no conflict of interests.

Figures

Figure 1
Figure 1
Study flow diagram for meta‐analysis of cardiac troponins and all‐cause mortality and/or cardiovascular outcomes in patients with symptomatic peripheral artery disease
Figure 2
Figure 2
Forest plots of adjusted hazard ratios (HRs) for baseline cardiac troponin to predict long‐term mortality in peripheral artery disease. (A) Funnel plot of adjusted HRs showing no publication bias (p = .24). (B) The meta‐analysis was conducted using the generic inverse variance method, and pooled HR was reported with 95% confidence interval (CI)
Figure 3
Figure 3
Forest plots of adjusted hazard ratios (HRs) for baseline cardiac troponin to predict long‐term major cardiovascular events (myocardial infarction, stroke, and cardiovascular death) in peripheral artery disease. (A) Funnel plot of adjusted HRs showing no publication bias (p = .10). (B) The meta‐analysis was conducted using the generic inverse variance method, and pooled HR was reported with 95% confidence interval (CI)
See this image and copyright information in PMC

References

    1. Fowkes FG, Aboyans V, Fowkes FJ, McDermott MM, Sampson UK, Criqui MH. Peripheral artery disease: epidemiology and global perspectives. Nat Rev Cardiol. 2017;14(3):156‐170. 10.1038/nrcardio.2016.179 - DOI - PubMed
    1. Aboyans V, Ricco JB, Bartelink MEL, et al. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS): document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries Endorsed by: the European Stroke Organization (ESO) The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J. 2018;39(9):763‐816. 10.1093/eurheartj/ehx095 - DOI - PubMed
    1. Steg PG, Bhatt DL, Wilson PW, et al. One‐year cardiovascular event rates in outpatients with atherothrombosis. JAMA. 2007;297(11):1197‐1206. 10.1001/jama.297.11.1197 - DOI - PubMed
    1. Lippi G, Cervellin G, Sanchis‐Gomar F. Predicting mortality with cardiac troponins: recent insights from meta‐analyses. Diagnosis. 2019;8(1):37‐49. 10.1515/dx-2019-0061 - DOI - PubMed
    1. Vrsalovic M. Prognostic effect of cardiac troponin elevation in acute aortic dissection: a meta‐analysis. Int J Cardiol. 2016;214:277‐278. 10.1016/j.ijcard.2016.03.230 - DOI - PubMed