Pre- and post-procedural troponin value as a biomarker of cardiovascular risk in peripheral artery disease patients undergoing endovascular revascularisation: a pilot study

Abstract Introduction Serial assessment of high-sensitivity cardiac troponin T or I (hs-cTnT/I) is recommended in cardiovascular (CV) disease patients following at least moderate-risk non-cardiac surgery or procedure, establishing the entity of peri-operative myocardial infarction/injury (PMI). The ESC guidelines define PMI as an absolute increase in hs-cTn T/I of more than the upper limit of normal on days 1 or 2 after the procedure. The prevalence of myocardial injury among peripheral artery disease patients, demonstrated by post-procedural troponin dynamics, is poorly documented. In one cohort of critical limb ischaemia patients, 62.1% had elevated baseline troponin and 25.5% presented with PMI (defined as an hs-cTnT value above 14 ng/L with a ≥30% relative increase from baseline). PMI was found to be an independent predictor of 1-year mortality and major adverse cardiovascular events. Purpose The aim of this pilot study was to establish the prevalence of increased baseline and post-endovascular revascularisation hs-cTnI values among peripheral artery disease patients. That would enable us to determine whether there is a rationale for assessing serial hs-cTnI in this group. If so, their already very high CV risk could be further stratified to even higher level according to previous evidence. Methods We included 107 peripheral artery disease patients hospitalised for planned endovascular revascularisation. In addition to standard evaluation, hs-cTnI was measured on the day of admission and 24 hours after the procedure. Rutherford class was recorded. Laboratory reference values for elevated hs-cTnI were ≥34 ng/L for men and ≥16 ng/L for women. The limit of detection of hs-cTnI was ≥10 ng/L. The number of patients fulfilling criteria for PMI according to ESC guidelines was noted. Descriptive statistics were performed. Results The mean age of participants was 72.8 ± 9.3 years; 33.6% were women and 66.4% men. The majority presented with moderate claudication (41.1%), whereas critical limb ischaemia was present in 36.4% of participants (Rutherford class 4–6). hs-cTnI values above the limit of detection (≥10 ng/L) were present in 26.1% of patients before the procedure and in 37.8% after the procedure. Elevated baseline hs-cTnI was found in 6 patients. In total, 4 patients (4%) met the criteria for PMI according to ESC guidelines; all were women, and 3 had critical limb ischaemia. Among all patients with critical limb ischaemia, 7.9% had PMI. Conclusions The prevalence of elevated pre- and post-procedural hs-cTnI in our peripheral artery disease study was lower than previously reported in critical limb ischaemia patients and among high-risk patients in general. A signal of post-procedural rise in hs-cTnI was observed despite only a minority of participants fulfilling the ESC definition of PMI. Nevertheless, a small subgroup of patients was identified that requires an even more intensive approach to CV preventive management.