Abstract
In patients with pulmonary embolism (PE), the impact of repeated troponin I or T (TnI/TnT) measurements remains unclear. Using Danish national registries, we identified PE patients (≥18years) hospitalized between 2013 and 2018 with initial TnI or TnT measurement within -1/+1day from admission and >1 repeated measurement within three days. Trajectories of TnI and TnT were identified using latent class trajectory modeling. Hazard ratios for 30-day mortality were compared across trajectories via multivariable Cox regression. Among 1539 patients with TnI measurements and 1323 with TnT measurements, three distinct trajectories were identified. Trajectory I (nTnI=286, nTnT=472) exhibited consistently low TnI/TnT concentrations, trajectory II (nTnI=1076, nTnT=724) demonstrated initial elevated TnI/TnT decreasing within 24h, and trajectory III (nTnI=177, nTnT=127) was characterized by elevated index TnI/TnT increasing within 10h. 30-day mortality rates were higher in trajectory II and III compared to I in both the TnI (3%, 7% and 18% across trajectory I to III) and the TnT (1%, 9% and 20% across trajectory I to III) cohort. After adjustment hazard ratio of 30-day mortality for trajectory II vs. I was 7.42 (95% CI 1.00-54.84, p=0.04, TnI) and 2.93 (95% CI 1.17-7.33, p=0.02 TnT); and for trajectory III vs. I, 16.42 (95% CI 2.42-127.29, p=0.007, TnI) and 8.21 (95% CI 2.78-24.19, p<0.001, TnT). A steep increase in TnI or TnT concentration within 10h of PE diagnosis significantly escalates 30-day mortality risk indicating that early serial sampling may enhance risk stratification of PE patients.
Published Version
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