Evidence map›Paper›PMID 38788767›Full record

ArticleThrombosis and haemostasis2024

Optimizing Use of High-Sensitivity Troponin for Risk-Stratification of Acute Pulmonary Embolism.

Sayhaan R Goraya, Connor O'Hare, Kelsey A Grace, William J Schaeffer, S Nabeel Hyder, Geoffrey D Barnes, Colin F Greineder

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Thrombosis and haemostasis, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. The Prognostic Value of Troponin in Acute Pulmonary Embolism: A Systematic Review and Meta-Analysis.Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2025
    Pooled it
  2. Review
  3. Review
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Sayhaan R GorayaUniversity of Michigan Medical School, Ann Arbor, Michigan, United States.ORCID 0000-0001-6865-229X
Connor O'HareDepartment of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, United States.
Kelsey A GraceDepartment of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, United States.
William J SchaefferDepartment of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, United States.
S Nabeel HyderDivision of Cardiovascular Medicine, Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, United States.
Geoffrey D BarnesUniversity of Michigan Medical School, Ann Arbor, Michigan, United States.ORCID 0000-0002-6532-8440
Colin F GreinederUniversity of Michigan Medical School, Ann Arbor, Michigan, United States.

Funding

Michigan Emergency Department Improvement Collaborative AltERnaTives to admission for Pulmonary Embolism (MEDIC ALERT PE) StudyR01HL163438 · NHLBI · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI Geoffrey Douglas Barnes, Colin Fred Greineder · 2023 to 2026
$3.0M
ICAM-1 targeted thrombomodulin: an experimental therapeutic for the Acute Respiratory Distress SyndromeK08HL130430 · NHLBI · UNIVERSITY OF PENNSYLVANIA · PI GREINEDER, COLIN FRED · 2016 to 2020
$665k
NHLBI NIH HHS K08 HL130430NHLBI NIH HHS R01 HL163438
6 · The paper itself

Abstract

backgroundHigh-sensitivity troponin T (HS-TnT) may improve risk-stratification in hemodynamically stable acute pulmonary embolism (PE), but an optimal strategy for combining this biomarker with clinical risk-stratification tools has not been determined. STUDY HYPOTHESIS: We hypothesized that different HS-TnT cutoff values may be optimal for identifying (1) low-risk patients who may be eligible for outpatient management and (2) patients at increased risk of clinical deterioration who might benefit from advanced PE therapies.

methodsRetrospective analysis of hemodynamically stable patients in the University of Michigan acute ED-PE registry with available HS-TnT values. Primary and secondary outcomes were 30-day mortality and need for intensive care unit-level care. Receiver operating characteristic curves were used to determine optimal HS-TnT cutoffs in the entire cohort, and for those at higher risk based on the simplified Pulmonary Embolism Severity Index (PESI) or imaging findings.

resultsThe optimal HS-TnT cutoff in the full cohort, 12 pg/mL, was significantly associated with 30-day mortality (odds ratio [OR]: 3.94, 95% confidence interval [CI]: 1.48-10.50) and remained a significant predictor after adjusting for the simplified PESI (sPESI) score and serum creatinine (adjusted OR: 3.05, 95% CI: 1.11-8.38). A HS-TnT cutoff of 87 pg/mL was associated with 30-day mortality (OR: 5.01, 95% CI: 2.08-12.06) in patients with sPESI ≥1 or right ventricular dysfunction.

conclusionIn this retrospective, single-center study of acute PE patients, we identified distinct optimal HS-TnT values for different clinical uses-a lower cutoff, which identified low-risk patients even in the absence of other risk-stratification methods, and a higher cutoff, which was strongly associated with adverse outcomes in patients at increased risk.

Indexed as

BiomarkersPulmonary EmbolismTroponin TAcute DiseaseAgedAged, 80 and overFemaleHumansMaleMichiganMiddle AgedPredictive Value of TestsPrognosisRegistriesRetrospective StudiesRisk AssessmentBiomarkersTroponin T

Identifiers

PMID38788767
PMCPMC12048199

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.