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Cardiac troponin testing and the simplified Pulmonary Embolism Severity Index : The SWIss Venous ThromboEmbolism Registry (SWIVTER)

Spirk, D. and Aujesky, D. and Husmann, M. and Hayoz, D. and Baldi, T. and Frauchiger, B. and Banyai, M. and Baumgartner, I. and Kucher, N.. (2011) Cardiac troponin testing and the simplified Pulmonary Embolism Severity Index : The SWIss Venous ThromboEmbolism Registry (SWIVTER). Thrombosis and haemostasis, Vol. 106, H. 5. pp. 978-984.

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Official URL: http://edoc.unibas.ch/dok/A6005325

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Abstract

A low simplified Pulmonary Embolism Severity Index (sPESI), defined as age ?80 years and absence of systemic hypotension, tachycardia, hypoxia, cancer, heart failure, and lung disease, identifies low-risk patients with acute pulmonary embolism (PE). It is unknown whether cardiac troponin testing improves the prediction of clinical outcomes if the sPESI is not low. In the prospective Swiss Venous Thromboembolism Registry, 369 patients with acute PE and a troponin test (conventional troponin T or I, highly sensitive troponin T) were enrolled from 18 hospitals. A positive test result was defined as a troponin level above the manufacturers assay threshold. Among the 106 (29%) patients with low sPESI, the rate of mortality or PE recurrence at 30 days was 1.0%. Among the 263 (71%) patients with high sPESI, 177 (67%) were troponin-negative and 86 (33%) troponin-positive; the rate of mortality or PE recurrence at 30 days was 4.6% vs. 12.8% (p=0.015), respectively. Overall, risk assessment with a troponin test (hazard ratio [HR] 3.39, 95% confidence interval [CI] 1.38-8.37; p=0.008) maintained its prognostic value for mortality or PE recurrence when adjusted for sPESI (HR 5.80, 95%CI 0.76-44.10; p=0.09). The combination of sPESI with a troponin test resulted in a greater area under the receiver-operating characteristic curve (HR 0.72, 95% CI 0.63-0.81) than sPESI alone (HR 0.63, 95% CI 0.57-0.68) (p=0.023). In conclusion, although cardiac troponin testing may not be required in patients with a low sPESI, it adds prognostic value for early death and recurrence for patients with a high sPESI.
Faculties and Departments:03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Angiologie
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Angiologie
UniBasel Contributors:Frauchiger, Beat
Item Type:Article, refereed
Article Subtype:Research Article
Bibsysno:Link to catalogue
Publisher:Schattauer
ISSN:0340-6245
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:25 Oct 2013 08:32
Deposited On:25 Oct 2013 08:32

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