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    Oral Communication

    Venous Thromboembolism

    Management of Venous Thromboembolism II

    OC 40.3 - High-sensitivity versus Conventional Troponin Cutoffs for Risk Stratification in Patients with Hemodynamically-stable Acute Pulmonary Embolism

    Monday, June 26, 2023
    15:15 – 15:30 ET
    Room: 517
    Session Available As: Live-Stream and On-Demand
    Background: High-sensitivity troponin tests detect modest troponin elevations in plasma, beyond the threshold of regular troponin tests. Whether low-grade troponin elevation correlates with outcomes of hemodynamically-stable patients with pulmonary embolism (PE) is unknown.

    Aims: To determine the association between high-sensitivity cardiac troponin I (hs-cTnI), compared with regular cardiac troponin I (cTnI), and PE risk designations according to the European Society of Cardiology (ESC) classification and outcomes in hemodynamically-stable patients with PE.

    Methods: Using the data from the prospective PROgnosTic valuE of Computed Tomography (PROTECT) study, cTnI (threshold of >0.05 ng/mL) and hs-cTnI (threshold of >0.029 ng/mL) at the time of PE diagnosis were compared with respect to ESC risk designation. The association between troponin values and 30-day complicated course (defined as hemodynamic collapse, recurrent PE, or death) was assessed.

    Results: 834 were included in this study (mean age: 67.5 years, 50.8% female). 139 patients (16.7%) had an elevated cTnI and 264 (31.7%) had an elevated hs-TnI. A 30-day complicated course occurred in 62 of 834 (7.4%; 95% CI: 5.7-9.4%) patients. Analyzing troponin elevation as a binary variable, elevated cTnI (OR: 2.84; 95% CI, 1.62-4.98), but not hs-cTnI (OR: 1.12; 95% CI: 0.65-1.93) was associated increased odds of a complicated course. Of 125 patients who had an elevated hs-cTnI but a normal cTnI, none (0%; 95% CI, 0-2.9%) developed a complicated course. Using the 2019 ESC risk stratification scheme, hs-TnI classified fewer patients as low-risk compared with cTnI (Figure). Among 78 patients designated as ESC low-risk when using cTnI but not with hsTnI, none (0%; 95% CI, 0-4.6%) had a complicated course (Table).

    Conclusion(s): In hemodynamically-stable patients with PE, hs-cTnI identified modest elevations in troponin levels. However, the results did not provide additive clinical value compared with cTnI but were associated with overestimation of the risk in 15% of participants.

    Learning Objectives:

    • To understand concepts about risk stratification in pulmonary embolism (PE)
    • To understand the potential utility of troponin for risk stratification in PE
    • To be able to discuss the tradeoffs of different tools for risk stratification in PE