Predictive Value of the High-Sensitivity Troponin T Assay and the Simplified Pulmonary Embolism Severity Index in Hemodynamically Stable Patients With Acute Pulmonary Embolism
- 13 December 2011
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 124 (24), 2716-2724
- https://doi.org/10.1161/circulationaha.111.051177
Abstract
Background—The new, high-sensitivity troponin T (hsTnT) assay may improve risk stratification of normotensive patients with acute pulmonary embolism (PE). We externally validated the prognostic value of hsTnT, and of the simplified Pulmonary Embolism Severity Index (sPESI), in a large multicenter cohort. Methods and Results—We prospectively examined 526 normotensive patients with acute PE; of those, 31 (5.9%) had an adverse 30-day outcome. The predefined hsTnT cutoff value of 14 pg/mL was associated with a high prognostic sensitivity and negative predictive value, comparable to those of the sPESI. Both hsTnT ≥14 pg/mL (OR, 4.97 [95% CI, 1.71–14.43]; P=0.003) and sPESI ≥1 point(s) (OR, 9.51 [2.24–40.29]; P=0.002) emerged, besides renal insufficiency (OR, 2.97 [1.42–6.22]; P=0.004), as predictors of early death or complications; in a multivariable model, they remained independent predictors of outcome (P=0.044 and 0.012, respectively). A total of 127 patients (24.1%) were identified as low risk by a sPESI of 0 and hsTnT P=0.001) and those with sPESI ≥1 (PP=0.005). Conclusions—The hsTnT assay and the sPESI improve risk stratification of acute PE. Combination of both modalities may yield additive prognostic information and particularly identify possible candidates for out-of-hospital treatment.This publication has 70 references indexed in Scilit:
- Highly sensitive troponin T assay in normotensive patients with acute pulmonary embolismEuropean Heart Journal, 2010
- Out of hospital treatment of acute pulmonary embolism in patients with a low NT‐proBNP levelJournal of Thrombosis and Haemostasis, 2010
- Elevated Heart-Type Fatty Acid-Binding Protein Levels on Admission Predict an Adverse Outcome in Normotensive Patients With Acute Pulmonary EmbolismJournal of the American College of Cardiology, 2010
- Analytical Validation of a High-Sensitivity Cardiac Troponin T AssayClinical Chemistry, 2010
- Thrombolysis for pulmonary embolism: Past, present and futureThrombosis and Haemostasis, 2010
- Sensitive Troponin I Assay in Early Diagnosis of Acute Myocardial InfarctionThe New England Journal of Medicine, 2009
- Outpatient treatment and early discharge of symptomatic pulmonary embolism: a systematic reviewEuropean Respiratory Journal, 2009
- Prognostic models for selecting patients with acute pulmonary embolism for initial outpatient therapyCurrent Opinion in Pulmonary Medicine, 2008
- Early discharge of patients with pulmonary embolism: a two-phase observational studyEuropean Respiratory Journal, 2007
- Validation of a clinical prognostic model to identify low‐risk patients with pulmonary embolismJournal of Internal Medicine, 2007