title: Cardiac troponin-T and the prediction of acute and long-term mortality after acute pulmonary embolism.
abstract: BACKGROUND
  Although cardiac troponin elevation during acute pulmonary embolism (PE) predicts in-hospital death, its long-term prognostic significance, and the role of troponin-T concentration in this prediction, is unknown. Moreover, its use in acute PE in elderly populations with multiple comorbidities is not well described.
  
  
  METHODS
  Consecutive patients presenting with confirmed PE to a tertiary hospital between 2000 and 2007 with troponin-T measured were identified retrospectively and their outcomes tracked from a state-wide death registry.
  
  
  RESULTS
  There were 577 patients, (47% male) with a mean age (± standard deviation) of 70.1 ± 15.2 years, of whom 19 died during index admission. Of the 558 patients who survived to discharge, 186 patients died during a mean follow-up of 3.8 ± 2.4 years. There were 187 (32%) patients with elevated troponin-T (≥ 0.01 μg/L). Troponin-T concentration was significantly and independently associated with in-hospital and long-term mortality whether analyzed as a continuous or categorical variable (p<0.001). However, different cut-points were required to optimally predict in-hospital and post-discharge long-term mortality in multivariate analysis. Troponin-T ≥ 0.01 μg/L was not an independent predictor of in-hospital or post-discharge survival. A cut-point of troponin-T ≥ 0.03 μg/L was required to independently predict in-hospital death (p=0.03), and troponin-T ≥ 0.1 μg/L was required to independently predict long-term mortality (hazard ratio 2.3, 95% confidence interval 1.4-3.8, p=0.001).
  
  
  CONCLUSIONS
  Troponin-T elevation during acute PE shows a concentration-dependent relationship with acute and long-term outcome. Concentrations of troponin-T well above the threshold for detection may be required to independently contribute to prediction of outcome in elderly populations with acute PE.
authors.affiliation: Cardiology Department, Concord Hospital, The University of Sydney, Hospital Road, Concord 2139, NSW, Australia. chin.ng@sydney.edu.au
authors.forename: Austin Chin Chwan
authors.initials: AC
authors.lastname: Ng
authors.forename: Andy Sze Chiang
authors.initials: AS
authors.lastname: Yong
authors.forename: Vincent
authors.initials: V
authors.lastname: Chow
authors.forename: Tommy
authors.initials: T
authors.lastname: Chung
authors.forename: Saul Benedict
authors.initials: SB
authors.lastname: Freedman
authors.forename: Leonard
authors.initials: L
authors.lastname: Kritharides
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D020107:Troponin T