Prognostic significance of cardiac troponin I on admission for surgical treatment of acute pulmonary embolism: a single-centre experience over more than 10 years

• Published in: European journal of cardio-thoracic surgery 2012-12, Vol.42 (6), p.951-957
• Main Authors: Thielmann, Matthias, Pasa, Susanne, Wendt, Daniel, Price, Vivien, Marggraf, Günter, Neuhäuser, Markus, Piotrowski, Adam, Jakob, Heinz
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; Aged; Biomarkers - blood; Cohort Studies; Embolectomy; Female; Hospital Mortality; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Preoperative Period; Prognosis; Pulmonary Embolism - blood; Pulmonary Embolism - diagnosis; Pulmonary Embolism - mortality; Pulmonary Embolism - surgery; Retrospective Studies; Risk Adjustment; Risk Assessment; Risk Factors; ROC Curve; Severity of Illness Index; Treatment Outcome; Troponin I - blood
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezs122

OBJECTIVES Cardiac troponin I (cTnI) is a highly sensitive, specific marker for myocardial cell injury. We sought to determine whether cTnI on admission may help to identify patients with increased risk of open surgical embolectomy with acute pulmonary embolism (PE). METHODS Forty-six consecutive patients with confirmed acute PE were enrolled in this prospective study. PE was confirmed by pulmonary angiography, computed tomography (CT) scan or echocardiography. Severity of PE was assessed by clinical data, and cTnI was measured within 12 h after admission. RESULTS cTnI was elevated in 28 patients with acute PE. Preoperative right ventricular dysfunction [odds ratio (OR): 15.2; 95% confidence interval (CI): 2.02-144.8; P < 0.002], prolonged hypotension with cardiogenic shock (OR: 14.9; 95% CI: 2.2-131.1; P < 0.002) and preoperative need for resuscitation (OR: 6.0; 95% CI: 0.6-143.8; P = 0.12) were more prevalent in patients with elevated cTnI serum concentrations. cTnI-positive patients were also more likely to require inotropic support (OR: 10.0; 95% CI: 1.8-65.1; P < 0.005) and mechanical ventilation (OR: 13.5; 95% CI: 2.2-95.6; P < 0.005). Moreover, an elevated cTnI level on admission significantly correlated with both primary endpoints, in-hospital mortality (OR: 9.0; 95% CI: 1.0-215.2; P = 0.03) and major adverse clinical events (OR: 8.3; 95% CI: 1.5-62.5; P = 0.006). After multivariable risk adjustment, a positive cTnI value remained an independent predictor of in-hospital mortality (OR: 13.6; 95% CI: 3.22-145.8; P = 0.014) and major adverse clinical events (OR: 15.7; 95% CI: 4.15-133.7; P = 0.031). CONCLUSIONS cTnI on admission may improve risk assessment of patients undergoing open surgical embolectomy due to acute PE.