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Troponin I and risk stratification of patients with acute nonmassive pulmonary embolism

Depts of ¹ Respiratory, ² Cardiology and, ³ Clinical Biochemistry, Ramón y Cajal Hospital, Madrid, Spain. ⁴ Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences, Washington University School of Medicine, St Louis, MO, USA.

CORRESPONDENCE: D. Jiménez Castro, Respiratory Dept, Ramón y Cajal Hospital, 28034 MadridSpain. Fax: 34 913368717. E-mail: djc_69_98{at}yahoo.com

Keywords: Prognosis, pulmonary embolism, troponin

Received: August 30, 2007
Accepted November 27, 2007

The assessment of risk and appropriate treatment of patients with acute pulmonary embolism (PE) remains a challenge.

The prognostic performance of cardiac troponin I (cTnI) in predicting 30-day all-cause mortality was prospectively assessed in consecutive haemodynamically stable patients with PE.

The present study included 318 haemodynamically stable patients with PE. During the 30-day study period, 23 (7%) patients died. cTnI was elevated (0.1 ng·mL^–1) in 102 (32%) patients. An age >65 yrs, systolic blood pressure <120 mmHg and severity of illness assessed using the PE severity index (PESI) were significantly associated with an increased risk for mortality, but no significant association was found between elevation of cTnI and 30-day mortality in a logistic regression analysis. When only fatal PE was considered, multivariate analysis showed that severity of illness using the PESI and an elevated cTnI (odds ratio 3.7, 95% confidence interval (CI) 1.1–12.8) were associated with a significant increase in the risk for death. The negative predictive value (95% CI) of a negative cTnI for mortality was 93 (90–97)%.

In conclusion, in haemodynamically stable patients with acute pulmonary embolism, cardiac troponin I was not an independent predictor of 30-day all-cause mortality, although it did predict fatal pulmonary embolism.