The long‐term prognostic value of highly sensitive cardiac troponin I in patients with acute pulmonary embolism

• Published in: Clinical cardiology (Mahwah, N.J.) N.J.), 2017-12, Vol.40 (12), p.1271-1278
• Main Authors: Lee Chuy, Katherine, Hakemi, Emad Uddin, Alyousef, Tareq, Dang, Geetanjali, Doukky, Rami
• Format: Article
• Language: English
• Subjects: Acute Disease; Clinical Investigations; Computed Tomography Angiography; Echocardiography; Electrocardiography; Embolisms; Female; Follow-Up Studies; Health risk assessment; Hospital Mortality - trends; Hospitalization - trends; Humans; Middle Aged; Mortality; Outcome; PESI; Predictive Value of Tests; Prognosis; Pulmonary arteries; Pulmonary Embolism; Pulmonary Embolism - blood; Pulmonary Embolism - diagnosis; Pulmonary Embolism - mortality; Pulmonary embolisms; Retrospective Studies; Risk Assessment; Severity of Illness Index; Survival Rate - trends; Time Factors; Troponin; Troponin I - blood; United States - epidemiology
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.22823

Background In patients with acute pulmonary embolism (PE), detectable levels of cardiac troponin I (cTnI) using a highly sensitive assay have been associated with increased in‐hospital mortality. We sought to investigate the impact of detectable cTnI on long‐term survival following acute PE. Hypothesis Detectable cTnI levels in patients presenting with acute PE predict increased long‐term mortality following hospital discharge. Methods In a retrospective cohort study, we analyzed consecutive patients with confirmed acute PE and cTnI assay available from the index hospitalization. The detectable cTnI level was ≥0.012 ng/mL. Patients were classified into low and high clinical risk groups according to the Pulmonary Embolism Severity Index (PESI) at presentation. Subjects were followed for all‐cause mortality subsequent to hospital discharge using chart review and Social Security Death Index. Results A cohort of 289 acute PE patients (mean age 56 years, 51% men), of whom 152 (53%) had a detectable cTnI, was followed for a mean of 3.1 ± 1.8 years after hospital discharge. A total of 71 deaths were observed; 44 (29%) and 27 (20%) in the detectable and undetectable cTnI groups, respectively (P = 0.05). Detectable cTnI was predictive of long‐term survival among low‐risk (P = 0.009) but not high‐risk patients (P = 0.78) who had high mortality rates irrespective of cTnI status. Conclusions In patients with acute PE, detectable cTnI is predictive of long‐term mortality, particularly among patients who were identified as low risk according to PESI score.