Plasma Troponins Identify Patients with Very Low-Risk Acute Pulmonary Embolism

Area of Science:

• Cardiology
• Pulmonary Medicine
• Biomarker Research

Background:

• Outpatient treatment for acute pulmonary embolism (APE) is common for low-risk patients.
• Risk stratification for very low-risk APE patients remains challenging.
• Current clinical assessment alone may be insufficient for safe home treatment decisions.

Purpose of the Study:

• To develop a risk stratification algorithm for APE patients with a simplified Pulmonary Embolism Severity Index (sPESI) of 0.
• To identify APE patients suitable for safe outpatient management.
• To refine risk assessment beyond clinical factors using biomarkers.

Main Methods:

• Post hoc analysis of a prospective study including 409 normotensive APE patients with sPESI 0.
• Assessment of cardiac troponin levels and echocardiographic evaluation for right ventricular dysfunction (RV/LV ratio > 1.0).
• Defined clinical endpoint (CE) as APE-related mortality, rescue thrombolysis, or immediate surgery due to deterioration.

Main Results:

• Elevated serum troponin levels were significantly associated with an increased risk of CE (p=0.000).
• Receiver operating characteristic (ROC) analysis demonstrated high predictive value for troponin (AUC=0.908, p < 0.001).
• A troponin cut-off value of >1.7 ULN showed 100% positive predictive value for CE; RV/LV > 1.0 was not significant.

Conclusions:

• Clinical risk assessment alone is insufficient for APE patients with sPESI 0.
• Myocardial damage biomarkers, specifically troponin, are essential for further risk stratification.
• APE patients with sPESI 0 and troponin levels ≤1.7 ULN represent a "very low risk" group with a favorable prognosis.