High-sensitivity troponin T levels ≥ 60 ng/L independently predicted a significantly higher risk of 30-day all-cause mortality (adjusted OR 5.45) compared to levels < 60 ng/L in patients with acute pulmonary embolism.
Cohort (n=374)
No
Does high-sensitivity troponin T (hsTnT) level predict 30-day adverse outcomes and mortality in patients with acute pulmonary embolism?
A high-sensitivity troponin T cut-off of ≥ 60 ng/L provides significant prognostic value for 30-day mortality and adverse outcomes in patients with acute pulmonary embolism.
Effect estimate: Adjusted OR 5.45 (95% CI 2.08-14.29)
Absolute Event Rate: 12.3% vs 1.7%
p-value: p=0.001
BACKGROUND/AIMS: Elevated troponin levels predict in-hospital mortality and influence decisions regarding thrombolytic therapy in patients with acute pulmonary embolism (PE). However, the usefulness of high-sensitivity troponin T (hsTnT) regarding PE remains uncertain. We aimed to establish the optimal cut-off level and compare its performance for precise risk stratification. METHODS: 374 patients diagnosed with acute PE were reviewed. PE-related adverse outcomes, a composite of PE-related deaths, cardiopulmonary resuscitation incidents, systolic blood pressure < 90 mmHg, and all-cause mortality within 30 days were evaluated. The optimal hsTnT cut-off for all-cause mortality, and the net reclassification index (NRI) was used to assess the incremental value in risk stratification. RESULTS: Among 343 normotensive patients, 17 (5.0%) experienced all-cause mortality, while 40 (10.7%) had PE-related adverse outcomes. An optimal hsTnT cut-off value of 60 ng/L for all-cause mortality (AUC 0.74, 95% CI 0.61-0.85, p < 0.001) was identified, which was significantly associated with PE-related adverse outcomes (OR 4.07, 95% CI 2.06-8.06, p < 0.001). Patients with hsTnT ≥ 60 ng/L were older, hypotensive, had higher creatinine levels, and right ventricular dysfunction signs. Combining hsTnT ≥ 60 ng/L with simplified pulmonary embolism severity index ≥1 provided additional prognostic information. Reclassification analysis showed a significant shift in risk categories, with an NRI of 1.016 ± 0.201 (p < 0.001). CONCLUSION: We refined troponin's predictive value in patients with acute PE, proposing a new cut-off value of hsTnT ≥ 60 ng/L. Validation through large-scale studies is essential to offer clinically useful guidance for managing patient population.
Kim et al. (Tue,) conducted a cohort in Acute pulmonary embolism (n=374). High-sensitivity troponin T (hsTnT) ≥ 60 ng/L vs. hsTnT < 60 ng/L was evaluated on All-cause mortality within 30 days (Adjusted OR 5.45, 95% CI 2.08-14.29, p=0.001). High-sensitivity troponin T levels ≥ 60 ng/L independently predicted a significantly higher risk of 30-day all-cause mortality (adjusted OR 5.45) compared to levels < 60 ng/L in patients with acute pulmonary embolism.