Clinical question: Is high-sensitivity cardiac troponin I (hs-cTnI) better at predicting outcomes for hemodynamically stable pulmonary embolism (PE) than conventional cardiac troponin I (cTnI)?
Background: Hs-cTnI is more sensitive compared to cTnI, but traditional PE risk scores rely on cTnI.
Study design: Multicenter cohort study
Setting: 12 hospital emergency departments in Spain
Synopsis: In post-analysis of the PROTECT study of 834 hemodynamically stable PE patients, 139 patients (16.7%) had a positive cTnI versus 264 hs-cTnI patients (31.7%). A complicated course (hemodynamic collapse, recurrent PE, or 30-day mortality) occurred in 62 patients (7.4%; 95% CI, 5.7-9.4). Hs-cTnI as a binary variable was not associated with significantly increased odds of a complicated course (odds ratio [OR], 1.12; (95% CI, 0.65-1.93) as compared to cTnI (OR, 2.84; 95% CI, 1.62-4.98). None of the 125 patients who had elevated hs-cTnI with normal cTnI developed a complicated course.
Using the European Society of Cardiology 2019 risk stratification and cTnI, 247 patients (29.6%) were designated as low-risk. Within this group, 78 (31.6%) had a positive hs-cTnI, but none had a complicated course.
Bottom line: In patients with stable PEs, hs-cTnI overestimated the 30-day risk of mortality and did not change risk stratification.
Citation: Bikdeli B, Muriel A, et al. High-sensitivity vs conventional troponin cutoffs for risk stratification in patients with acute pulmonary embolism. JAMA Cardiol. 2024;9(1):64-70.
Dr. Kochar
Dr. Kochar is a hospitalist in the department of hospital medicine at Mount Sinai Hospital, and an assistant professor of medicine at the Icahn School of Medicine in New York.