Objective To evaluate the predictive value of the high-sensitivity cardiac troponin I (hs-cTnI) in patients with acute pulmonary embolism (APE).
Methods In a retrospective cohort study,272 consecutive patients with APE were reviewed and the 30-days death and in-hospital adverse events were evaluated. The patients were classified according to hs-cTnI value into a high hs-cTnI group and a low hs-cTnI group. The simple pulmonary embolism severity index (sPESI) was used for clinical risk determination. The adverse event was defined as intravenous thrombolytic therapy,noninvasive ventilator support to maintain oxygen saturation >90% and suffered with severe complications. The correlations of hs-cTnI with sPESI score,30-days adverse events and mortality were analyzed. The Kaplan-Meier curves and the log-rank test were used to compare time-to-event survival. Stepwise multivariate logistic regression analysis models were used to determine the incremental prognostic value of sPESI score and hs-cTnI.
Results The incidence of 30-day death (6.1%),renal failure (14.6%),bleeding (13.4%) and thrombolytic therapy (7.9%) were higher in the high hs-cTnI group than those in the low hs-cTnI group (P values were 0.009,<0.001,0.018 and 0.003,respectively). The patients with sPESI ≥1 and low hs-cTnI had greater free adverse events survival (P=0.005). hs-cTnI provided incremental predictive value for in-hospital adverse events,beyond the sPESI score (P<0.001).
Conclusion hs-cTnI has excellent negative predictive value of APE prognosis,especially when used combined with sPESI score.
Citation：
XiXin, LiuZeying, ZhangYing, LiYamin, WangLvya, LiuShuang. Predictive Value of the High-Sensitivity Cardiac Troponin I in Patients with Acute Pulmonary Embolism. Chinese Journal of Respiratory and Critical Care Medicine, 2015, 14(3): 278-281. doi: 10.7507/1671-6205.2015068
Copy
Copyright © the editorial department of Chinese Journal of Respiratory and Critical Care Medicine of West China Medical Publisher. All rights reserved
| 1. |
Konstantinides SV,Torbicki A,Agnelli G,et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J,2014,35:3033-3073.
|
| 2. |
Piran S,Le Gal G,Wells PS,et al. Outpatient treatment of symptomatic pulmonary embolism:a systematic review and meta-analysis. Thromb Res,2013,132:515-519.
|
| 3. |
Becattini C,Vedovati MC,Agnelli G. Prognostic value of troponins in acute pulmonary embolism:a meta-analysis. Circulation,2007,116:427-433.
|
| 4. |
Zondag W,Kooiman J,Klok FA,et al. Outpatient versus inpatient treatment in patients with pulmonary embolism:a meta-analysis. Eur Respir J,2013,42:134-144.
|
| 5. |
Elf JE,Jögi J,Bajc M. Home treatment of patients with small to medium sized acute pulmonary embolism. J Thromb Thrombolysis,2015,39:166-172.
|
| 6. |
Gallotta G,Palmieri V,Piedimonte V,et al. Increased troponin I predicts in-hospital occurrence of hemodynamic instability in patients with sub-massive or non-massive pulmonary embolism independent to clinical,echocardiographic and laboratory information. Int J Cardiol,2008,124:351-357.
|
| 7. |
Lankeit M,Jimenez D,Kostrubiec M,et al. Predictive value of the high-sensitivity troponin T assay and the simplified pulmonary embolism severity index in hemodynamically stable patients with acute pulmonary embolism:a prospective validation study. Circulation,2011,124:2716-2724.
|
| 8. |
Lankeit M,Friesen D,Aschoff J,et al. Highly sensitive troponin T assay in normotensive patients with acute pulmonary embolism. Eur Heart J,2010,31:1836-1844.
|
| 9. |
Hakemi EU,Alyousef T,Dang G,et al. The prognostic value of undetectable highly sensitive cardiac troponin I in patients with acute pulmonary embolism. Chest,2015,147:685-694.
|
- 1. Konstantinides SV,Torbicki A,Agnelli G,et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J,2014,35:3033-3073.
- 2. Piran S,Le Gal G,Wells PS,et al. Outpatient treatment of symptomatic pulmonary embolism:a systematic review and meta-analysis. Thromb Res,2013,132:515-519.
- 3. Becattini C,Vedovati MC,Agnelli G. Prognostic value of troponins in acute pulmonary embolism:a meta-analysis. Circulation,2007,116:427-433.
- 4. Zondag W,Kooiman J,Klok FA,et al. Outpatient versus inpatient treatment in patients with pulmonary embolism:a meta-analysis. Eur Respir J,2013,42:134-144.
- 5. Elf JE,Jögi J,Bajc M. Home treatment of patients with small to medium sized acute pulmonary embolism. J Thromb Thrombolysis,2015,39:166-172.
- 6. Gallotta G,Palmieri V,Piedimonte V,et al. Increased troponin I predicts in-hospital occurrence of hemodynamic instability in patients with sub-massive or non-massive pulmonary embolism independent to clinical,echocardiographic and laboratory information. Int J Cardiol,2008,124:351-357.
- 7. Lankeit M,Jimenez D,Kostrubiec M,et al. Predictive value of the high-sensitivity troponin T assay and the simplified pulmonary embolism severity index in hemodynamically stable patients with acute pulmonary embolism:a prospective validation study. Circulation,2011,124:2716-2724.
- 8. Lankeit M,Friesen D,Aschoff J,et al. Highly sensitive troponin T assay in normotensive patients with acute pulmonary embolism. Eur Heart J,2010,31:1836-1844.
- 9. Hakemi EU,Alyousef T,Dang G,et al. The prognostic value of undetectable highly sensitive cardiac troponin I in patients with acute pulmonary embolism. Chest,2015,147:685-694.
