Predictive value and optimal cut-off level of high-sensitivity troponin T in patients with acute pulmonary embolism
- Author:
Moojun KIM
1
;
Chang-Ok SEO
;
Yong-Lee KIM
;
Hangyul KIM
;
Hye Ree KIM
;
Yun Ho CHO
;
Jeong Yoon JANG
;
Jong-Hwa AHN
;
Min Gyu KANG
;
Kyehwan KIM
;
Jin-Sin KOH
;
Seok-Jae HWANG
;
Jin Yong HWANG
;
Jeong Rang PARK
Author Information
- Publication Type:2
- From:The Korean Journal of Internal Medicine 2025;40(1):65-77
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background/Aims:Elevated troponin levels predict in-hospital mortality and influence decisions regarding thrombolytic therapy in patients with acute pulmonary embolism (PE). However, the usefulness of high-sensitivity troponin T (hsTnT) regarding PE remains uncertain. We aimed to establish the optimal cut-off level and compare its performance for precise risk stratification.
Methods:374 patients diagnosed with acute PE were reviewed. PE-related adverse outcomes, a composite of PE-related deaths, cardiopulmonary resuscitation incidents, systolic blood pressure < 90 mmHg, and all-cause mortality within 30 days were evaluated. The optimal hsTnT cut-off for all-cause mortality, and the net reclassification index (NRI) was used to assess the incremental value in risk stratification.
Results:Among 343 normotensive patients, 17 (5.0%) experienced all-cause mortality, while 40 (10.7%) had PE-related adverse outcomes. An optimal hsTnT cut-off value of 60 ng/L for all-cause mortality (AUC 0.74, 95% CI 0.61–0.85, p < 0.001) was identified, which was significantly associated with PE-related adverse outcomes (OR 4.07, 95% CI 2.06–8.06, p < 0.001). Patients with hsTnT ≥ 60 ng/L were older, hypotensive, had higher creatinine levels, and right ventricular dysfunction signs. Combining hsTnT ≥ 60 ng/L with simplified pulmonary embolism severity index ≥1 provided additional prognostic information. Reclassification analysis showed a significant shift in risk categories, with an NRI of 1.016 ± 0.201 (p < 0.001).
Conclusions:We refined troponin’s predictive value in patients with acute PE, proposing a new cut-off value of hsTnT ≥ 60 ng/L. Validation through large-scale studies is essential to offer clinically useful guidance for managing patient population.
