Sonne-Holm Emilie, Kjærgaard Jesper, Bang Lia E, Køber Lars, Fosbøl Emil, Hassager Christian, Beske Rasmus Paulin, Carlsen Jørn, Winther-Jensen Matilde
Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark.
Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark.
Thromb Res. 2025 Mar;247:109274. doi: 10.1016/j.thromres.2025.109274. Epub 2025 Jan 22.
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 (≥18 years) hospitalized between 2013 and 2018 with initial TnI or TnT measurement within -1/+1 day 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 (n = 286, n = 472) exhibited consistently low TnI/TnT concentrations, trajectory II (n = 1076, n = 724) demonstrated initial elevated TnI/TnT decreasing within 24 h, and trajectory III (n = 177, n = 127) was characterized by elevated index TnI/TnT increasing within 10 h. 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 10 h of PE diagnosis significantly escalates 30-day mortality risk indicating that early serial sampling may enhance risk stratification of PE patients.
在肺栓塞（PE）患者中，重复检测肌钙蛋白I或T（TnI/TnT）的影响尚不清楚。
利用丹麦国家登记系统，我们确定了2013年至2018年期间住院的PE患者（≥18岁），其初始TnI或TnT检测在入院前-1/+1天内进行，且在三天内有超过1次的重复检测。使用潜在类别轨迹模型确定TnI和TnT的轨迹。通过多变量Cox回归比较各轨迹30天死亡率的风险比。
在1539例检测TnI的患者和1323例检测TnT的患者中，确定了三种不同的轨迹。轨迹I（n = 286，n = 472）显示TnI/TnT浓度持续较低，轨迹II（n = 1076，n = 724）显示初始TnI/TnT升高，在24小时内下降，轨迹III（n = 177，n = 127）的特征是TnI/TnT指数升高，在10小时内增加。在TnI队列（轨迹I至III分别为3%、7%和18%）和TnT队列（轨迹I至III分别为1%、9%和20%）中，轨迹II和III的30天死亡率均高于轨迹I。调整后，轨迹II与轨迹I相比，30天死亡率的风险比为7.42（95%CI 1.00-54.84，p = 0.04，TnI）和2.93（95%CI 1.17-7.33，p = 0.02，TnT）；轨迹III与轨迹I相比，风险比为16.42（95%CI 2.42-127.29，p = 0.007，TnI）和8.21（95%CI 2.78-24.19，p < 0.001，TnT）。
PE诊断后10小时内TnI或TnT浓度急剧升高显著增加30天死亡风险，表明早期系列采样可能增强PE患者的风险分层。
