Cardiac troponin-T and the prediction of acute and long-term mortality after acute pulmonary embolism.
Int J Cardiol. 2011 Aug 22;
Authors: Ng AC, Yong AS, Chow V, Chung T, Freedman SB, Kritharides L
Abstract
BACKGROUND: Although cardiac troponin elevation during acute pulmonary embolism (PE) predicts in-hospital death, its long-term prognostic significance, and the role of troponin-T concentration in this prediction, is unknown. Moreover, its use in acute PE in elderly populations with multiple comorbidities is not well described. METHODS: Consecutive patients presenting with confirmed PE to a tertiary hospital between 2000 and 2007 with troponin-T measured were identified retrospectively and their outcomes tracked from a state-wide death registry. RESULTS: There were 577 patients, (47% male) with a mean age (±standard deviation) of 70.1±15.2years, of whom 19 died during index admission. Of the 558 patients who survived to discharge, 186 patients died during a mean follow-up of 3.8±2.4years. There were 187 (32%) patients with elevated troponin-T (?0.01?g/L). Troponin-T concentration was significantly and independently associated with in-hospital and long-term mortality whether analyzed as a continuous or categorical variable (p<0.001). However, different cut-points were required to optimally predict in-hospital and post-discharge long-term mortality in multivariate analysis. Troponin-T?0.01?g/L was not an independent predictor of in-hospital or post-discharge survival. A cut-point of troponin-T?0.03?g/L was required to independently predict in-hospital death (p=0.03), and troponin-T?0.1?g/L was required to independently predict long-term mortality (hazard ratio 2.3, 95% confidence interval 1.4-3.8, p=0.001). CONCLUSIONS: Troponin-T elevation during acute PE shows a concentration-dependent relationship with acute and long-term outcome. Concentrations of troponin-T well above the threshold for detection may be required to independently contribute to prediction of outcome in elderly populations with acute PE.
PMID: 21864916 [PubMed - as supplied by publisher]