PE risk stratification not aided by troponin measurements
MedWire News: Measuring levels of troponin I (cTnI) does not improve risk assessment using the Pulmonary Embolism Severity Index (PEIS), study findings show.
In patients with acute PE, elevated cardiac biomarkers, such as cTnI, indicate right-ventricular stress and are associated with an increased risk for fatal PE and mortality, while low levels have a high negative predictive value for these outcomes.
“Thus, troponin testing has been proposed as an additional tool for identifying low-risk patients who might be eligible for outpatient therapy,” explain David Jiménez (Ramón y Cajal Hospital, Madrid, Spain) and co-authors.
To investigate further, the team assessed 567 patients with confirmed acute symptomatic PE for risk using the PESI and cTnI levels at time of hospital admission. Patients were divided into the five PESI risk categories and followed-up for 30 days.
Overall, just 1.3% of patients with a low PESI class I–II and low cTnI level (<0.1 ng/ml) died during follow-up compared with 14.2% of those with a PESI class III–IV and low cTnI level. No patient with a PESI class I–II and elevated cTnI (≥0.1 ng/ml) died but the mortality rate was 15.4% among patients with a PESI class III–IV and elevated cTnI.
A low risk PESI score of I–II had a higher negative predictive value for mortality than low cTnI (98.9% vs 90.8%), the researchers report in the Journal of Thrombosis and Haemostasis.
Furthermore, adding troponin to the PESI did not improve sensitivity, specificity, or positive and negative predictive values compared with PESI alone.
“The present study further validates the use of the PESI for risk stratification and prognosis of outpatients with non-massive PE,” conclude Jiménez et al.
They add: “The safety and effectiveness of outpatient treatment of low-risk patients based on the PESI is currently being tested in a randomized controlled study, and the results should clarify the role of the PESI in guiding the management of such patients.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
By Lynda Williams