Cardiac troponin testing and the simplified Pulmonary Embolism Severity Index

David Spirk; Drahomir Aujesky; Marc Husmann; Daniel Hayoz; Thomas Baldi; Beat Frauchiger; Martin Banyai; Iris Baumgartner; Nils Kucher

doi:10.1160/TH11-06-0371

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2011; 106(05): 978-984
DOI: 10.1160/TH11-06-0371

New Technologies, Diagnostic Tools and Drugs

Schattauer GmbH

Cardiac troponin testing and the simplified Pulmonary Embolism Severity Index

The SWIss Venous ThromboEmbolism Registry (SWIVTER)

David Spirk

¹Medical Affairs, Sanofi-Aventis (Suisse) SA, Meyrin, Switzerland

,

Drahomir Aujesky

²Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland

,

Marc Husmann

³Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland

,

Daniel Hayoz

⁴Department of Internal Medicine, Cantonal Hospital Fribourg, Fribourg, Switzerland

,

Thomas Baldi

⁵Department of Internal Medicine, University Hospital Basel, Basel, Switzerland

,

Beat Frauchiger

⁶Department of Internal Medicine, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland

,

Martin Banyai

⁷Department of Internal Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland

,

Iris Baumgartner

⁸Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland

,

Nils Kucher

⁸Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland

› Author Affiliations

Abstract

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Summary

A low simplified Pulmonary Embolism Severity Index (sPESI), defined as age ≤80 years and absence of systemic hypotension, tachycardia, hypoxia, cancer, heart failure, and lung disease, identifies low-risk patients with acute pulmonary embolism (PE). It is unknown whether cardiac troponin testing improves the prediction of clinical outcomes if the sPESI is not low. In the prospective Swiss Venous Thromboembolism Registry, 369 patients with acute PE and a troponin test (conventional troponin T or I, highly sensitive troponin T) were enrolled from 18 hospitals. A positive test result was defined as a troponin level above the manufacturers assay threshold. Among the 106 (29%) patients with low sPESI, the rate of mortality or PE recurrence at 30 days was 1.0%. Among the 263 (71%) patients with high sPESI, 177 (67%) were troponin-negative and 86 (33%) troponin-positive; the rate of mortality or PE recurrence at 30 days was 4.6% vs. 12.8% (p=0.015), respectively. Overall, risk assessment with a troponin test (hazard ratio [HR] 3.39, 95% confidence interval [CI] 1.38–8.37; p=0.008) maintained its prognostic value for mortality or PE recurrence when adjusted for sPESI (HR 5.80, 95%CI 0.76–44.10; p=0.09). The combination of sPESI with a troponin test resulted in a greater area under the receiver-operating characteristic curve (HR 0.72, 95% CI 0.63–0.81) than sPESI alone (HR 0.63, 95% CI 0.57–0.68) (p=0.023). In conclusion, although cardiac troponin testing may not be required in patients with a low sPESI, it adds prognostic value for early death and recurrence for patients with a high sPESI.

Keywords

Pulmonary embolism - risk stratification - Pulmonary Embolism Severity Index - cardiac troponin

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References

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