Predictive Value of the High-Sensitivity Troponin T Assay and the Simplified Pulmonary Embolism Severity Index in Hemodynamically Stable Patients With Acute Pulmonary Embolism A Prospective Validation Study

被引:212
作者
Lankeit, Mareike [2 ]
Jimenez, David [3 ,4 ]
Kostrubiec, Maciej [5 ]
Dellas, Claudia [2 ]
Hasenfuss, Gerd [2 ]
Pruszczyk, Piotr [5 ]
Konstantinides, Stavros [1 ,2 ]
机构
[1] Democritus Univ Thrace, Dept Cardiol, Alexandroupolis 68100, Greece
[2] Univ Gottingen, Dept Cardiol & Pulmonol, D-3400 Gottingen, Germany
[3] Alcala de Henares Univ, IRYCIS, Hosp Ramon y Cajal, Resp Dept, Madrid, Spain
[4] Alcala de Henares Univ, IRYCIS, Hosp Ramon y Cajal, Dept Med, Madrid, Spain
[5] Med Univ Warsaw, Dept Internal Med & Cardiol, Warsaw, Poland
关键词
embolism; pulmonary heart disease; prognosis; complications; ACID-BINDING PROTEIN; RIGHT-VENTRICULAR DYSFUNCTION; CLINICAL PROGNOSTIC MODEL; LOW-RISK PATIENTS; VENOUS THROMBOEMBOLISM; MYOCARDIAL-INFARCTION; NORMOTENSIVE PATIENTS; EARLY-DIAGNOSIS; EARLY DISCHARGE; METAANALYSIS;
D O I
10.1161/CIRCULATIONAHA.111.051177
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-The new, high-sensitivity troponin T (hsTnT) assay may improve risk stratification of normotensive patients with acute pulmonary embolism (PE). We externally validated the prognostic value of hsTnT, and of the simplified Pulmonary Embolism Severity Index (sPESI), in a large multicenter cohort. Methods and Results-We prospectively examined 526 normotensive patients with acute PE; of those, 31 (5.9%) had an adverse 30-day outcome. The predefined hsTnT cutoff value of 14 pg/mL was associated with a high prognostic sensitivity and negative predictive value, comparable to those of the sPESI. Both hsTnT >= 14 pg/mL (OR, 4.97 [95% CI, 1.71-14.43]; P=0.003) and sPESI >= 1 point(s) (OR, 9.51 [2.24-40.29]; P=0.002) emerged, besides renal insufficiency (OR, 2.97 [1.42-6.22]; P=0.004), as predictors of early death or complications; in a multivariable model, they remained independent predictors of outcome (P=0.044 and 0.012, respectively). A total of 127 patients (24.1%) were identified as low risk by a sPESI of 0 and hsTnT >= 14 pg/mL; none of them had an adverse 30-day outcome. During 6-month follow-up, 52 patients (9.9%) died. Kaplan-Meier analysis illustrated that patients with hsTnT >= 14 pg/mL (P=0.001) and those with sPESI >= 1 (P=0.001) had a decreased probability of 6-month survival. Patients with sPESI of 0 and hsTnT >= 14 pg/mL at baseline had a 42% reduction in the risk of dying (hazard ratio, 0.58 [0.01-0.42]; P=0.005). Conclusions-The hsTnT assay and the sPESI improve risk stratification of acute PE. Combination of both modalities may yield additive prognostic information and particularly identify possible candidates for out-of-hospital treatment. (Circulation. 2011;124:2716-2724.)
引用
收藏
页码:2716 / U300
页数:10
相关论文
共 33 条
[11]   Elevated Heart-Type Fatty Acid-Binding Protein Levels on Admission Predict an Adverse Outcome in Normotensive Patients With Acute Pulmonary Embolism [J].
Dellas, Claudia ;
Puls, Miriam ;
Lankeit, Mareike ;
Schaefer, Katrin ;
Cuny, Mayumi ;
Berner, Maik ;
Hasenfuss, Gerd ;
Konstantinides, Stavros .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2010, 55 (19) :2150-2157
[12]   Prospective validation of the Pulmonary Embolism Severity Index A clinical prognostic model for pulmonary embolism [J].
Donze, Jacques ;
Le Gal, Gregoire ;
Fine, Michael J. ;
Roy, Pierre-Marie ;
Sanchez, Olivier ;
Verschuren, Franck ;
Cornuz, Jacques ;
Meyer, Guy ;
Perrier, Arnaud ;
Righini, Marc ;
Aujesky, Drahomir .
THROMBOSIS AND HAEMOSTASIS, 2008, 100 (05) :943-948
[13]   Analytical Validation of a High-Sensitivity Cardiac Troponin T Assay [J].
Giannitsis, Evangelos ;
Kurz, Kerstin ;
Hallermayer, Klaus ;
Jarausch, Jochen ;
Jaffe, Allan S. ;
Katus, Hugo A. .
CLINICAL CHEMISTRY, 2010, 56 (02) :254-261
[14]   Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension [J].
Jaff, Michael R. ;
McMurtry, M. Sean ;
Archer, Stephen L. ;
Cushman, Mary ;
Goldenberg, Neil ;
Goldhaber, Samuel Z. ;
Jenkins, J. Stephen ;
Kline, Jeffrey A. ;
Michaels, Andrew D. ;
Thistlethwaite, Patricia ;
Vedantham, Suresh ;
White, R. James ;
Zierler, Brenda K. .
CIRCULATION, 2011, 123 (16) :1788-1830
[15]   Prognostic models for selecting patients with acute pulmonary embolism for initial outpatient therapy [J].
Jimenez, David ;
Yusen, Roger D. .
CURRENT OPINION IN PULMONARY MEDICINE, 2008, 14 (05) :414-421
[16]   Simplification of the Pulmonary Embolism Severity Index for Prognostication in Patients With Acute Symptomatic Pulmonary Embolism [J].
Jimenez, David ;
Aujesky, Drahomir ;
Moores, Lisa ;
Gomez, Vicente ;
Luis Lobo, Jose ;
Uresandi, Fernando ;
Otero, Remedios ;
Monreal, Manuel ;
Muriel, Alfonso ;
Yusen, Roger D. .
ARCHIVES OF INTERNAL MEDICINE, 2010, 170 (15) :1383-1389
[17]   Troponin-Based Risk Stratification of Patients With Acute Nonmassive Pulmonary Embolism Systematic Review and Metaanalysis [J].
Jimenez, David ;
Uresandi, Fernando ;
Otero, Remedios ;
Lobo, Jose Luis ;
Monreal, Manuel ;
Marti, David ;
Zamora, Javier ;
Muriel, Alfonso ;
Aujesky, Drahomir ;
Yusen, Roger D. .
CHEST, 2009, 136 (04) :974-982
[18]   Plasma heart-type fatty acid binding protein is superior to troponin and myoglobin for rapid risk stratification in acute pulmonary embolism [J].
Kaczynska, Anna ;
Pelsers, Maurice M. A. L. ;
Bochowicz, Anna ;
Kostrubiec, Maciej ;
Glatz, Jan F. C. ;
Pruszczyk, Piotr .
CLINICA CHIMICA ACTA, 2006, 371 (1-2) :117-123
[19]   Sensitive Troponin I Assay in Early Diagnosis of Acute Myocardial Infarction. [J].
Keller, Till ;
Zeller, Tanja ;
Peetz, Dirk ;
Tzikas, Stergios ;
Roth, Alexander ;
Czyz, Ewa ;
Bickel, Christoph ;
Baldus, Stephan ;
Warnholtz, Ascan ;
Froehlich, Meike ;
Sinning, Christoph R. ;
Eleftheriadis, Medea S. ;
Wild, Philipp S. ;
Schnabel, Renate B. ;
Lubos, Edith ;
Jachmann, Nicole ;
Genth-Zotz, Sabine ;
Post, Felix ;
Nicaud, Viviane ;
Tiret, Laurence ;
Lackner, Karl J. ;
Muenzel, Thomas ;
Blankenberg, Stefan .
NEW ENGLAND JOURNAL OF MEDICINE, 2009, 361 (09) :868-877
[20]   Brain-type natriuretic peptide levels in the prediction of adverse outcome in patients with pulmonary embolism - A systematic review and meta-analysis [J].
Klok, Frederikus A. ;
Mos, Inge C. M. ;
Huisman, Menno V. .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2008, 178 (04) :425-430