TY - JOUR

T1 - Troponin dependent 30-day mortality in patients with acute pulmonary embolism

AU - Sonne-Holm, Emilie

AU - Winther-Jensen, Matilde

AU - Bang, Lia E.

AU - Køber, Lars

AU - Fosbøl, Emil

AU - Carlsen, Jørn

AU - Kjaergaard, Jesper

N1 - Publisher Copyright: © 2023, The Author(s).

PY - 2023

Y1 - 2023

N2 - Background: Troponin concentrations above upper reference are associated with increased mortality in patients with pulmonary embolism (PE). We aimed to assess whether risk of 30-day mortality increases in a dose-response relationship with concentration of troponin. Methods: Using Danish national registries, we identified patients ≥ 18 years of age hospitalized with first-time PE between 2013 and 2018 and available troponin measurements − 1/+1 day from admission. Patients were stratified into quintiles by increasing troponin concentration. Risk of 30-day mortality was assessed performing cumulative mortality curves and Cox regression model comparing the troponin quintiles. Results: We identified 5,639 PE patients of which 3,278 (58%) had a troponin concentration above upper reference. These patients were older (74 years), 50% male and with heavier comorbidity compared to patients with non-elevated troponin. We found increasing 30-day mortality with increasing troponin concentration (1% in 1st quintile (95% CI 0.5–1.5%), 2% in 2nd quintile (95% CI 1-2.5%), 8% in 3rd quintile (95% CI 5–9%), 11% in 4th quintile (95% CI 9–13%) and 15% in 5th quintile (95% CI 13–16%), confirmed in a Cox model comparing 1st quintile with 2nd quintile (HR 1.09; 95% CI 0.58–2.02), 3rd quintile (HR 3.68; 95% CI 2.20–6.15), 4th quintile (HR 5.51; 95% CI 3.34–9.10) and 5th quintile (HR 8.09; 95% CI 4.95–13.23). Conclusion: 30-day mortality was strongly associated with troponin concentration useful for improving risk stratification, treatment strategies and outcomes in PE patients.

AB - Background: Troponin concentrations above upper reference are associated with increased mortality in patients with pulmonary embolism (PE). We aimed to assess whether risk of 30-day mortality increases in a dose-response relationship with concentration of troponin. Methods: Using Danish national registries, we identified patients ≥ 18 years of age hospitalized with first-time PE between 2013 and 2018 and available troponin measurements − 1/+1 day from admission. Patients were stratified into quintiles by increasing troponin concentration. Risk of 30-day mortality was assessed performing cumulative mortality curves and Cox regression model comparing the troponin quintiles. Results: We identified 5,639 PE patients of which 3,278 (58%) had a troponin concentration above upper reference. These patients were older (74 years), 50% male and with heavier comorbidity compared to patients with non-elevated troponin. We found increasing 30-day mortality with increasing troponin concentration (1% in 1st quintile (95% CI 0.5–1.5%), 2% in 2nd quintile (95% CI 1-2.5%), 8% in 3rd quintile (95% CI 5–9%), 11% in 4th quintile (95% CI 9–13%) and 15% in 5th quintile (95% CI 13–16%), confirmed in a Cox model comparing 1st quintile with 2nd quintile (HR 1.09; 95% CI 0.58–2.02), 3rd quintile (HR 3.68; 95% CI 2.20–6.15), 4th quintile (HR 5.51; 95% CI 3.34–9.10) and 5th quintile (HR 8.09; 95% CI 4.95–13.23). Conclusion: 30-day mortality was strongly associated with troponin concentration useful for improving risk stratification, treatment strategies and outcomes in PE patients.

KW - Epidemiology

KW - Mortality

KW - Pulmonary embolism

KW - Risk assessment

KW - Troponin

U2 - 10.1007/s11239-023-02864-0

DO - 10.1007/s11239-023-02864-0

M3 - Journal article

C2 - 37486553

AN - SCOPUS:85165591921

VL - 56

SP - 485

EP - 494

JO - Journal of Thrombosis and Thrombolysis

JF - Journal of Thrombosis and Thrombolysis

SN - 0929-5305

IS - 3

ER -