Mouselimis Dimitrios, Hagstotz Saskia, Lichtenberg Michael, Donas Konstantinos P, Heinrich Ulrike, Avranas Konstantinos, Dimitriadis Zisis, Blessing Erwin, Langhoff Ralf, Frey Norbert, Katus Hugo A, Korosoglou Grigorios
Cardiology, Vascular Medicine & Pneumology, GRN Hospital Weinheim, Roentgentrasse 1, 69469 Weinheim, Germany.
Vascular Center Klinikum Arnsberg, 59821 Arnsberg, Germany.
J Clin Med. 2022 Dec 8;11(24):7287. doi: 10.3390/jcm11247287.
Many patients with peripheral arterial disease (PAD) exhibit undiagnosed obstructive coronary artery disease. We aim to identify the patients with lifestyle limiting claudication due to PAD and without cardiac symptoms, requiring coronary revascularization based on high-sensitive troponin T (hsTnT) values. We assessed hsTnT in consecutive patients referred for elective endovascular treatment due to claudication [Rutherford categories (RC) 2 & 3] between January 2018 and December 2021. Diagnostic work-up by non-invasive imaging and, if required, cardiac catheterization was performed according to clinical data, ECG findings and baseline hsTnT. The occurrence of cardiac death, myocardial infarction or urgent revascularization during follow-up was the primary endpoint. Of 346 patients, 14 (4.0%) exhibited elevated hsTnT ≥ 14 ng/L, including 7 (2.0%) with acute myocardial injury by serial hsTnT sampling. Coronary revascularization by percutaneous coronary intervention was necessary in 6 of 332 (1.5%) patients with normal versus nine of 14 (64.3%) patients with elevated hsTnT (p < 0.001). During 2.4 ± 1.4 years of follow-up, 20 of 286 (7.0%) patients with normal versus four of 13 (30.8%) with elevated hsTnT at baseline reached the composite primary endpoint (p = 0.03 by log-rank test). In conclusion, elevated troponins in cardiac asymptomatic patients with claudication modify subsequent cardiac management and may increase the need for closer surveillance and more aggressive conservative management in polyvascular disease.
许多外周动脉疾病（PAD）患者存在未被诊断出的阻塞性冠状动脉疾病。我们旨在识别因PAD导致生活方式受限性跛行且无心脏症状、需根据高敏肌钙蛋白T（hsTnT）值进行冠状动脉血运重建的患者。我们评估了2018年1月至2021年12月期间因跛行（卢瑟福分类[RC]2级和3级）而接受择期血管内治疗的连续患者的hsTnT。根据临床数据、心电图结果和基线hsTnT，通过无创成像进行诊断性检查，必要时进行心脏导管检查。随访期间心脏死亡、心肌梗死或紧急血运重建的发生情况为主要终点。在346例患者中，14例（4.0%）hsTnT升高≥14 ng/L，其中7例（2.0%）通过连续hsTnT采样诊断为急性心肌损伤。332例hsTnT正常的患者中有6例（1.5%）需要通过经皮冠状动脉介入进行冠状动脉血运重建，而14例hsTnT升高的患者中有9例（64.3%）需要（p<0.001）。在2.4±1.4年的随访期间，286例基线hsTnT正常的患者中有20例（7.0%）达到复合主要终点，而13例基线hsTnT升高的患者中有4例（30.8%）达到（对数秩检验p=0.03）。总之，有跛行症状的无症状心脏患者肌钙蛋白升高会改变后续心脏管理，可能增加对多血管疾病进行更密切监测和更积极保守治疗的需求。
