High-Sensitivity Troponin as a Predictor of Decompensation in Patients with Pulmonary Embolus

To determine which patients with pulmonary embolism (PE) are stable enough for outpatient management, investigators have studied troponin, right-ventricular strain, lactic acid, and clinical scoring systems (NEJM JW Emerg Med March 2015; [e-pub] and Chest 2015 Jan 29; [e-pub]; NEJM JW Emerg Med March 2014 and Chest 2013 Nov; 144:1539; and NEJM JW Emerg Med May 2013 and Ann Emerg Med 2013 Mar; 61:330). In a chart review study at a Chicago hospital, investigators examined adverse events in patients with PE according to whether they had elevation of high-sensitivity troponin I (hsT).

Of 298 consecutive patients with acute PE, 55% were hsT positive. Notably, 7% of the hsT-negative group had systolic blood pressure ≤100 mm Hg, and 23% had a heart…