共 33 条
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
论文数: 0 引用数: 0
h-index: 0
机构:
Univ Gottingen, Dept Cardiol & Pulmonol, D-3400 Gottingen, Germany Democritus Univ Thrace, Dept Cardiol, Alexandroupolis 68100, Greece

Jimenez, David
论文数: 0 引用数: 0
h-index: 0
机构:
Alcala de Henares Univ, IRYCIS, Hosp Ramon y Cajal, Resp Dept, Madrid, Spain
Alcala de Henares Univ, IRYCIS, Hosp Ramon y Cajal, Dept Med, Madrid, Spain Democritus Univ Thrace, Dept Cardiol, Alexandroupolis 68100, Greece

Kostrubiec, Maciej
论文数: 0 引用数: 0
h-index: 0
机构:
Med Univ Warsaw, Dept Internal Med & Cardiol, Warsaw, Poland Democritus Univ Thrace, Dept Cardiol, Alexandroupolis 68100, Greece

Dellas, Claudia
论文数: 0 引用数: 0
h-index: 0
机构:
Univ Gottingen, Dept Cardiol & Pulmonol, D-3400 Gottingen, Germany Democritus Univ Thrace, Dept Cardiol, Alexandroupolis 68100, Greece

Hasenfuss, Gerd
论文数: 0 引用数: 0
h-index: 0
机构:
Univ Gottingen, Dept Cardiol & Pulmonol, D-3400 Gottingen, Germany Democritus Univ Thrace, Dept Cardiol, Alexandroupolis 68100, Greece

Pruszczyk, Piotr
论文数: 0 引用数: 0
h-index: 0
机构:
Med Univ Warsaw, Dept Internal Med & Cardiol, Warsaw, Poland Democritus Univ Thrace, Dept Cardiol, Alexandroupolis 68100, Greece

Konstantinides, Stavros
论文数: 0 引用数: 0
h-index: 0
机构:
Democritus Univ Thrace, Dept Cardiol, Alexandroupolis 68100, Greece
Univ Gottingen, Dept Cardiol & Pulmonol, D-3400 Gottingen, Germany Democritus Univ Thrace, Dept Cardiol, Alexandroupolis 68100, Greece
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
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h-index: 0
机构:
Johannes Gutenberg Univ Mainz, Univ Med Ctr, Dept Med 2, Mainz, Germany Johannes Gutenberg Univ Mainz, Univ Med Ctr, Dept Med 2, Mainz, Germany

Wild, Philipp S.
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Johannes Gutenberg Univ Mainz, Univ Med Ctr, Dept Med 2, Mainz, Germany Johannes Gutenberg Univ Mainz, Univ Med Ctr, Dept Med 2, Mainz, Germany

Schnabel, Renate B.
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Johannes Gutenberg Univ Mainz, Univ Med Ctr, Dept Med 2, Mainz, Germany
Boston Univ, Sch Med, Framingham Heart Study, Framingham, MA USA Johannes Gutenberg Univ Mainz, Univ Med Ctr, Dept Med 2, Mainz, Germany

Lubos, Edith
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Johannes Gutenberg Univ Mainz, Univ Med Ctr, Dept Med 2, Mainz, Germany
Harvard Univ, Sch Med, Boston, MA USA
Brigham & Womens Hosp, Dept Med, Boston, MA 02115 USA Johannes Gutenberg Univ Mainz, Univ Med Ctr, Dept Med 2, Mainz, Germany

Jachmann, Nicole
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Johannes Gutenberg Univ Mainz, Univ Med Ctr, Inst Clin Chem & Lab Med, Mainz, Germany Johannes Gutenberg Univ Mainz, Univ Med Ctr, Dept Med 2, Mainz, Germany

Genth-Zotz, Sabine
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Johannes Gutenberg Univ Mainz, Univ Med Ctr, Dept Med 2, Mainz, Germany Johannes Gutenberg Univ Mainz, Univ Med Ctr, Dept Med 2, Mainz, Germany

Post, Felix
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Johannes Gutenberg Univ Mainz, Univ Med Ctr, Dept Med 2, Mainz, Germany Johannes Gutenberg Univ Mainz, Univ Med Ctr, Dept Med 2, Mainz, Germany

Nicaud, Viviane
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Univ Paris 06, INSERM, U525, Paris, France Johannes Gutenberg Univ Mainz, Univ Med Ctr, Dept Med 2, Mainz, Germany

Tiret, Laurence
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Univ Paris 06, INSERM, U525, Paris, France Johannes Gutenberg Univ Mainz, Univ Med Ctr, Dept Med 2, Mainz, Germany

Lackner, Karl J.
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Johannes Gutenberg Univ Mainz, Univ Med Ctr, Inst Clin Chem & Lab Med, Mainz, Germany Johannes Gutenberg Univ Mainz, Univ Med Ctr, Dept Med 2, Mainz, Germany

Muenzel, Thomas
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Johannes Gutenberg Univ Mainz, Univ Med Ctr, Dept Med 2, Mainz, Germany Johannes Gutenberg Univ Mainz, Univ Med Ctr, Dept Med 2, Mainz, Germany

Blankenberg, Stefan
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Johannes Gutenberg Univ Mainz, Univ Med Ctr, Dept Med 2, Mainz, Germany Johannes Gutenberg Univ Mainz, Univ Med Ctr, Dept Med 2, Mainz, Germany
[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

Klok, Frederikus A.
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机构:
Leiden Univ, Med Ctr, Dept Gen Internal Med Endocrinol, Sect Vasc Med, Leiden, Netherlands Leiden Univ, Med Ctr, Dept Gen Internal Med Endocrinol, Sect Vasc Med, Leiden, Netherlands

Mos, Inge C. M.
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h-index: 0
机构:
Leiden Univ, Med Ctr, Dept Gen Internal Med Endocrinol, Sect Vasc Med, Leiden, Netherlands Leiden Univ, Med Ctr, Dept Gen Internal Med Endocrinol, Sect Vasc Med, Leiden, Netherlands

Huisman, Menno V.
论文数: 0 引用数: 0
h-index: 0
机构:
Leiden Univ, Med Ctr, Dept Gen Internal Med Endocrinol, Sect Vasc Med, Leiden, Netherlands Leiden Univ, Med Ctr, Dept Gen Internal Med Endocrinol, Sect Vasc Med, Leiden, Netherlands