Troponin-Based Risk Stratification of Patients With Acute Nonmassive Pulmonary Embolism

Jiménez, David; Uresandi, Fernando; Otero, Remedios; Lobo, José Luís; Monréal, Manuel; Sánchez, David Martí; Zamora, Javier; Muriel, Alfonso; Aujesky, Drahomir; Yusen, Roger D.

doi:10.1378/chest.09-0608

Cited by 194 publications

(114 citation statements)

References 40 publications

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“…Studies published between 1998 and 2007 with a total of 1,985 patients were included in a metaanalysis, which showed that cardiac troponin elevation was associated with an increased risk of death (OR 5.24, 95% CI 3.28-8.38) and major adverse events (OR 7.03, 95% CI 2.42-20.43) in the acute phase [48]. However, another meta-analysis that excluded hypotensive patients was unable to confirm the prognostic value of circulating cardiac troponin levels [49]. Recently developed high-sensitivity assays may improve the prognostic performance of this biomarker at the low-risk end of the severity spectrum.…”

Section: Initial Anticoagulation For Pe: Current Regimens and Strategiesmentioning

confidence: 99%

Is it time for home treatment of pulmonary embolism?

Lankeit

Konstantinides

2012

Eur Respir J

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Acute pulmonary embolism (PE) is a frequent cause of death, but not all patients are at high risk of an adverse early outcome. It has been proposed that selected patients may be considered for early discharge and home treatment, but it was only recently that improved risk assessment strategies permitted advances in the identification of low-risk PE.Clinical prediction rules, such as the Pulmonary Embolism Severity Index (PESI), and laboratory biomarkers, particularly natriuretic peptides and cardiac troponins, appeared capable of excluding severe PE and serious comorbidity.Recently, two randomised trials and two prospective cohort studies investigated the feasibility and safety of outpatient treatment. All excluded patients with haemodynamic instability and serious comorbidity, but only one trial used a validated clinical score (PESI) for patient inclusion, and only one cohort study employed a biomarker test. Overall, 90-day outcome was favourable and the results appear promising.To optimise patient selection, future trials will need to test simplified clinical scores combined with high-sensitivity biomarker assays, and it will have to be determined whether echocardiography and/or compression ultrasonography are also required before discharge. Furthermore, ongoing trials will show whether new oral anticoagulants are a safe and cost-effective option for managing patients out of hospital.

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Section: Initial Anticoagulation For Pe: Current Regimens and Strategiesmentioning

confidence: 99%

Is it time for home treatment of pulmonary embolism?

Lankeit

Konstantinides

2012

Eur Respir J

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“…Cardiac troponin‐T (TnT) and troponin‐I (TnI) are sensitive and specific markers of myocardial injury and have prognostic implications in many primary noncardiac illnesses including pulmonary embolism, subarachnoid hemorrhage, and stroke 4, 5. Increased sensitivity of the contemporary TnT assay has resulted in more frequent clinical detection of myocardial injury from noncoronary causes, including critical illness 5, 6.…”

Section: Introductionmentioning

confidence: 99%

Role of Admission Troponin‐T and Serial Troponin‐T Testing in Predicting Outcomes in Severe Sepsis and Septic Shock

Vallabhajosyula

Sakhuja

Geske

et al. 2017

JAHA

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BackgroundTroponin‐T elevation is seen commonly in sepsis and septic shock patients admitted to the intensive care unit. We sought to evaluate the role of admission and serial troponin‐T testing in the prognostication of these patients.Methods and ResultsThis was a retrospective cohort study from 2007 to 2014 on patients admitted to the intensive care units at the Mayo Clinic with severe sepsis and septic shock. Elevated admission troponin‐T and significant delta troponin‐T were defined as ≥0.01 ng/mL and ≥0.03 ng/mL in 3 hours, respectively. The primary outcome was in‐hospital mortality. Secondary outcomes included 1‐year mortality and lengths of stay. During this 8‐year period, 944 patients met the inclusion criteria with 845 (90%) having an admission troponin‐T ≥0.01 ng/mL. Serial troponin‐T values were available in 732 (78%) patients. Elevated admission troponin‐T was associated with older age, higher baseline comorbidity, and severity of illness, whereas significant delta troponin‐T was associated with higher severity of illness. Admission log10 troponin‐T was associated with unadjusted in‐hospital (odds ratio 1.6; P=0.003) and 1‐year mortality (odds ratio 1.3; P=0.04), but did not correlate with length of stay. Elevated delta troponin‐T and log10 delta troponin‐T were not significantly associated with any of the primary or secondary outcomes. Admission log10 troponin‐T remained an independent predictor of in‐hospital mortality (odds ratio 1.4; P=0.04) and 1‐year survival (hazard ratio 1.3; P=0.008).ConclusionsIn patients with sepsis and septic shock, elevated admission troponin‐T was associated with higher short‐ and long‐term mortality. Routine serial troponin‐T testing did not add incremental prognostic value in these patients.

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“…9) [239]. Повышение концентрации тропонина сопровождалось высокой летальностью как в общей популяции (ОШ -9,44 %; 95% ный ДИ -4,14-21,49), так и у гемодинамически стабиль ных пациентов (ОШ -5,90 %; 95% ный ДИ -2,68-12,95), эти результаты были неизменными для тропонина I и Т. Однако в других исследованиях прогностическое значение повышенного уровня тропонина у больных с нормальным АД было неве лико [240].…”

Section: маркеры повреждения миокардаunclassified

Pulmonary embolism: clinical guidelines of European Society of Cardiology (2014).The Task Force of the European Society of Cardiology for diagnosis and management of pulmonary embolism

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2015

Pulʹmonologiâ (Mosk.)

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РезюмеВ данных Клинических рекомендациях суммированы все современные доказательства по диагностике и лечению тромбоэмболии легочной артерии (ТЭЛА). В отличие от предыдущей версии рекомендаций, в данном документе представлены упрощенные варианты клинических прогностических шкал, подробно рассмотрена стратификация риска летального исхода, включая промежуточные степени риска, представлены новые подходы к АКТ, в т. ч. системному тромболизису и катетерным методам лечения, терапии антагонистом витамина К, определено место новых пероральных антикоагулянтов в терапии ТЭЛА. Ключевые слова: рекомендации, тромбоэмболия легочной артерии, венозный тромбоз, шок, гипотензия, торакалгия, одышка, сердеч ная недостаточность, диагностика, антикоагулянты, тромболизис. SummaryThese clinical recommendations summarized currently available evidence on diagnosis and management of patients with pulmonary embolism. When compared to previous version of recommendations, this document has introduced simplified clinical prognostic scales and a new risk stratifi cation system including intermediate risk. Novel approach to anticoagulant therapy have been also reviewed including systemic thrombolysis, catheter directed treatment, vitamin K antagonists and new oral anticoagulants. Key words: recommendations, pulmonary embolism, venous thromboembolism, shock, hypotension, chest pain, dyspnea, heart failure, diagnosis, anticoagulants, thrombolysis.Тромбоэмболия легочной артерии: клинические рекомендации Европейского общества кардиологов (2014) 526Пульмонология. 2015; 25 (5): 525-552 возникавших в ходе работы над Рекомендациями, надлежало информировать ЕОК и вносить соответ ствующие поправки. Финансирование Рабочей груп пы проводилось за счет средств ЕОК полностью, без участия представителей медицинской промышлен ности.Комитетом ЕОК по Практическим рекомендаци ям проведены наблюдение за процессом подготовки новых Клинических рекомендаций и его координа ция. Члены Комитета также несли ответственность за утверждение новых Клинических рекомендаций. Клинические рекомендации ЕОК активно проана лизированы Комитетом по Практическим рекомен дациям и внешними экспертами. После соответст вующих поправок Рекомендации были одобрены всеми экспертами Рабочей группы. Окончательный документ был утвержден Комитетом по Практичес ким рекомендациям для публикации в журнале European Heart Journal.Задача написания Клинических рекомендаций ЕОК заключается не только в объединении результа тов исследований последних лет, но также и в разра ботке образовательных методик и программ внедре ния Рекомендаций в практическое здравоохранение.Для практического использования Рекоменда ций готовится их краткая («карманная») версия, а также слайды, буклеты с ключевыми положения ми, листовки для неспециалистов и электронная версия для смартфонов и других гаджетов (сокра щенные варианты); с полным текст Рекомендаций опубликован на сайте ЕОК и находится в свободном доступе. Национальным обществам рекомендуется утверждать, переводить на национальные языки и внедрять Клинические рекоме...

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Troponin-Based Risk Stratification of Patients With Acute Nonmassive Pulmonary Embolism

Cited by 194 publications

References 40 publications

Is it time for home treatment of pulmonary embolism?

Is it time for home treatment of pulmonary embolism?

Role of Admission Troponin‐T and Serial Troponin‐T Testing in Predicting Outcomes in Severe Sepsis and Septic Shock

Pulmonary embolism: clinical guidelines of European Society of Cardiology (2014).The Task Force of the European Society of Cardiology for diagnosis and management of pulmonary embolism

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