Importance High-sensitivity troponin tests can detect even milder cardiac troponin elevations in plasma, beyond the threshold of conventional troponin tests. Whether detection of low-grade cardiac troponin elevation is associated with outcomes of patients with hemodynamically stable pulmonary embolism (PE) and helps with risk stratification is unknown. Objective To determine the association between high-sensitivity cardiac troponin I (hs-cTnI) compared with conventional cardiac troponin I (cTnI) and PE risk designations according to the European Society of Cardiology (ESC) 2019 classification scheme and clinical outcomes in patients with hemodynamically stable PE. Design, Setting, and Participants This is a post hoc analysis of data from the prospective Prognostic Value of Computed Tomography (PROTECT) multicenter cohort study enrolling patients from 12 hospital emergency departments in Spain. In this analysis, cTnI and hs-cTnI were compared with respect to ESC risk designation, and the association between troponin values and a complicated course after PE diagnosis was evaluated. Of 848 patients enrolled in PROTECT, 834 (98.3%) had hsTnI and cTnI values available and were included in the present analysis. Data were analyzed from May to December 2022. Exposures Troponin blood testing with cTnI (threshold of >0.05 ng/mL) vs hs-cTnI (threshold of >0.029 ng/mL) assays at the time of PE diagnosis. Main Outcomes Complicated course, defined as hemodynamic collapse, recurrent PE, or all-cause death, within 30 days after PE. Results Of 834 patients (mean [SEM] age, 67.5 [0.6] years; 424 [50.8%] female), 139 (16.7%) had elevated cTnI and 264 (31.7%) elevated hs-TnI, respectively. During follow-up, 62 patients (7.4%; 95% CI, 5.7-9.4) had a complicated course. Analyzing troponin elevation as a binary variable, elevated cTnI (odds ratio [OR], 2.84; 95% CI, 1.62-4.98) but not hs-cTnI (OR, 1.12; 95% CI, 0.65-1.93) was associated with increased odds of a complicated course. Of 125 patients who had elevated hs-cTnI but normal cTnI, none (0; 95% CI, 0.0-2.9) developed a complicated course. Using the 2019 ESC risk stratification scheme, hs-TnI classified fewer patients as low risk compared with cTnI. Among 78 patients designated as ESC low risk when using cTnI but not with hsTnI, none (0; 95% CI, 0.0-4.6) had a complicated course. Conclusions and Relevance In this study of patients with hemodynamically stable PE, hs-cTnI identified modest elevations in cardiac troponin levels. However, the results did not provide additive clinical value compared with cTnI. These findings suggest that use of hs-cTnI may result in overestimation of the risk in patients with stable PE.

中文翻译：

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急性肺栓塞患者风险分层的高灵敏度与传统肌钙蛋白截止值。

重要性 高灵敏度肌钙蛋白测试可以检测血浆中更轻微的心肌肌钙蛋白升高，超出传统肌钙蛋白测试的阈值。检测低度心肌肌钙蛋白升高是否与血流动力学稳定的肺栓塞 (PE) 患者的预后相关并有助于风险分层尚不清楚。目的 根据欧洲心脏病学会 (ESC) 2019 年分类方案确定高敏心肌肌钙蛋白 I (hs-cTnI) 与传统心肌肌钙蛋白 I (cTnI) 相比与 PE 风险指定之间的关联以及血流动力学异常患者的临床结果稳定的PE。设计、设置和参与者 这是对计算机断层扫描前瞻性预后价值 (PROTECT) 多中心队列研究数据的事后分析，该研究招募了来自西班牙 12 家医院急诊科的患者。在此分析中，比较了 cTnI 和 hs-cTnI 与 ESC 风险指定的关系，并评估了肌钙蛋白值与 PE 诊断后复杂病程之间的关联。在参加 PROTECT 的 848 名患者中，834 名 (98.3%) 具有可用的 hsTnI 和 cTnI 值，并纳入本分析。数据分析时间为 2022 年 5 月至 12 月。 暴露 在 PE 诊断时，使用 cTnI（阈值 >0.05 ng/mL）与 hs-cTnI（阈值 >0.029 ng/mL）进行肌钙蛋白血液检测。主要结局 复杂病程，定义为 PE 后 30 天内血流动力学崩溃、复发性 PE 或全因死亡。结果 834 名患者（平均 [SEM] 年龄，67.5 [0.6] 岁；424 名女性 [50.8%]）中，分别有 139 名（16.7%）cTnI 升高和 264 名（31.7%）hs-TnI 升高。随访期间，62 名患者（7.4%；95% CI，5.7-9.4）病程复杂。将肌钙蛋白升高作为二元变量进行分析，cTnI 升高（比值比 [OR]，2.84；95% CI，1.62-4.98）而非 hs-cTnI（OR，1.12；95% CI，0.65-1.93）与比值增加相关。一个复杂的课程。在 125 名 hs-cTnI 升高但 cTnI 正常的患者中，没有一人（0；95% CI，0.0-2.9）出现复杂病程。使用 2019 年 ESC 风险分层方案，与 cTnI 相比，hs-TnI 将更少的患者分类为低风险。在使用 cTnI 而未使用 hsTnI 时被指定为 ESC 低风险的 78 名患者中，没有一人（0；95% CI，0.0-4.6）有复杂的病程。结论和相关性 在这项针对血流动力学稳定的 PE 患者的研究中，hs-cTnI 发现心肌肌钙蛋白水平适度升高。然而，与 cTnI 相比，该结果并未提供额外的临床价值。这些发现表明，使用 hs-cTnI 可能会导致高估稳定型 PE 患者的风险。