title: Prognostic significance of cardiac troponin I on admission for surgical treatment of acute pulmonary embolism: a single-centre experience over more than 10 years.
abstract: OBJECTIVE
  Cardiac troponin I (cTnI) is a highly sensitive, specific marker for myocardial cell injury. We sought to determine whether cTnI on admission may help to identify patients with increased risk of open surgical embolectomy with acute pulmonary embolism (PE).
  
  
  METHODS
  Forty-six consecutive patients with confirmed acute PE were enrolled in this prospective study. PE was confirmed by pulmonary angiography, computed tomography (CT) scan or echocardiography. Severity of PE was assessed by clinical data, and cTnI was measured within 12 h after admission.
  
  
  RESULTS
  cTnI was elevated in 28 patients with acute PE. Preoperative right ventricular dysfunction [odds ratio (OR): 15.2; 95% confidence interval (CI): 2.02-144.8; P < 0.002], prolonged hypotension with cardiogenic shock (OR: 14.9; 95% CI: 2.2-131.1; P < 0.002) and preoperative need for resuscitation (OR: 6.0; 95% CI: 0.6-143.8; P = 0.12) were more prevalent in patients with elevated cTnI serum concentrations. cTnI-positive patients were also more likely to require inotropic support (OR: 10.0; 95% CI: 1.8-65.1; P < 0.005) and mechanical ventilation (OR: 13.5; 95% CI: 2.2-95.6; P < 0.005). Moreover, an elevated cTnI level on admission significantly correlated with both primary endpoints, in-hospital mortality (OR: 9.0; 95% CI: 1.0-215.2; P = 0.03) and major adverse clinical events (OR: 8.3; 95% CI: 1.5-62.5; P = 0.006). After multivariable risk adjustment, a positive cTnI value remained an independent predictor of in-hospital mortality (OR: 13.6; 95% CI: 3.22-145.8; P = 0.014) and major adverse clinical events (OR: 15.7; 95% CI: 4.15-133.7; P = 0.031).
  
  
  CONCLUSIONS
  cTnI on admission may improve risk assessment of patients undergoing open surgical embolectomy due to acute PE.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital Essen, Essen, Germany. matthias.thielmann@uni-due.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Thielmann
authors.forename: Susanne
authors.initials: S
authors.lastname: Pasa
authors.forename: Daniel
authors.initials: D
authors.lastname: Wendt
authors.forename: Vivien
authors.initials: V
authors.lastname: Price
authors.forename: Günter
authors.initials: G
authors.lastname: Marggraf
authors.forename: Markus
authors.initials: M
authors.lastname: Neuhäuser
authors.forename: Adam
authors.initials: A
authors.lastname: Piotrowski
authors.forename: Heinz
authors.initials: H
authors.lastname: Jakob
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D017128:Embolectomy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D057234:Preoperative Period; D011379:Prognosis; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012372:ROC Curve; D012189:Retrospective Studies; D020379:Risk Adjustment; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I