Sex-Specific Cutoffs for High-Sensitivity Troponin I in the Risk Stratification of Hemodynamically Stable Pulmonary Embolism

High-sensitivity cardiac troponin I (hs-cTnI) is frequently elevated in patients with pulmonary embolism (PE), although its prognostic value in hemodynamically stable cases and the optimal cutoff points for risk stratification remain unclear. This prospective observational study included consecutive patients with symptomatic, hemodynamically stable PE from 2018 to 2023 at a tertiary hospital. Hs-cTnI levels were measured at diagnosis, and sex-specific cutoff points were determined for a 30-day composite outcome, defined as PE-related mortality, non-PE-related mortality, hemodynamic instability, reperfusion treatment, or admission to the intensive care unit. The secondary outcome was to compare the clinical performance of the European Society of Cardiology (ESC) classification and the modified FAST score when applying sex-specific hs-cTnI cutoff points. Among the 720 patients included, 39.5% had elevated hs-cTnI levels, with a higher prevalence in women (49.1% vs. 30.4%). The composite outcome occurred in 8.4% of men and 7.1% of women. The optimal hs-cTnI cutoff points for predicting the primary outcome were ≥ 25 pg/mL in women and ≥ 50 pg/mL in men. Elevated hs-cTnI was independently associated with the composite outcome in the total sample, with consistent association in women (adjusted odds ratio [aOR]: 10.1, 95% CI: 2.1–48) and men (aOR: 9.8, 95% CI: 2.9–32.6). The ESC score preserved an optimal negative likelihood ratio of 0. This study identified sex-specific hs-cTnI cutoff points that improve the clinical performance while maintaining high negative predictive value and reducing false positives in hemodynamically stable PE.