The Prognostic Value of Undetectable Highly Sensitive Cardiac Troponin I in Patients with Acute Pulmonary Embolism.

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The Prognostic Value of Undetectable Highly Sensitive Cardiac Troponin I in Patients with Acute Pulmonary Embolism.

Chest. 2014 Jul 31;

Authors: Hakemi EU, Alyousef T, Dang G, Hakmei J, Doukky R

Abstract
ABSTRACT: Background:Elevated cardiac troponin levels have been shown to be associated with adverse outcome in patients with acute pulmonary embolism (PE). However, there is less data addressing the management implications of undetectable cardiac troponin-I (cTnI) using a highly sensitive assay. We hypothesized that undetectable cTnI predicts very low in-hospital adverse event rates. Methods:In a retrospective cohort study, we classified patients with confirmed acute PE according to cTnI detectability into cTnI+ and cTnI- groups. The Pulmonary Embolism Severity Index (PESI) was used for clinical risk determination. The primary outcome was a composite of hard events; defined as in-hospital death, cardiopulmonary resuscitation, or thrombolytic therapy. The secondary outcome was a composite of soft events; defined as intensive care unit admission, or inferior vena cava filter placement. Results:Among 298 consecutive patients with confirmed acute PE; 161(55%) were cTnI+ and 137(45%) were cTnI-. No deaths (0%) occurred in the cTnI- group vs. 9(6%) in the cTnI+ group (P=0.004). No hard events (0%) were observed in the cTnI- group vs. 15(9%) in the cTnI+ group (P<0.001). Soft events were observed at a lower rate in the cTn- group [21(15%) vs. 69(43%), P<0.001]. Patients in cTnI- groups had higher survival free of hard (P=0.001) or soft (P<0.001) events, irrespective of clinical risk. Furthermore, cTnI provided incremental prognostic value beyond clinical, electrocardiographic, and imaging data (P<0.001). Conclusions:Highly sensitive cTnI assay provides an excellent prognostic negative predictive value, thus it has a role in identifying candidates for out-of-hospital treatment of acute PE.
Background: Elevated cardiac troponin levels have been shown to be associated with adverse outcome in patients with acute pulmonary embolism (PE). However, there is less data addressing the management implications of undetectable cardiac troponin-I (cTnI) using a highly sensitive assay. We hypothesized that undetectable cTnI predicts very low in-hospital adverse event rates.
Methods: In a retrospective cohort study, we classified patients with confirmed acute PE according to cTnI detectability into cTnI+ and cTnI- groups. The Pulmonary Embolism Severity Index (PESI) was used for clinical risk determination. The primary outcome was a composite of hard events; defined as in-hospital death, cardiopulmonary resuscitation, or thrombolytic therapy. The secondary outcome was a composite of soft events; defined as intensive care unit admission, or inferior vena cava filter placement.
Results: Among 298 consecutive patients with confirmed acute PE; 161(55%) were cTnI+ and 137(45%) were cTnI-. No deaths (0%) occurred in the cTnI- group vs. 9(6%) in the cTnI+ group (P=0.004). No hard events (0%) were observed in the cTnI- group vs. 15(9%) in the cTnI+ group (P<0.001). Soft events were observed at a lower rate in the cTn- group [21(15%) vs. 69(43%), P<0.001]. Patients in cTnI- groups had higher survival free of hard (P=0.001) or soft (P<0.001) events, irrespective of clinical risk. Furthermore, cTnI provided incremental prognostic value beyond clinical, electrocardiographic, and imaging data (P<0.001).
Conclusions: Highly sensitive cTnI assay provides an excellent prognostic negative predictive value, thus it has a role in identifying candidates for out-of-hospital treatment of acute PE.

PMID: 25079900 [PubMed - as supplied by publisher]

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