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

Objectives: 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. © The Author 2012. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.