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J Thromb Haemost. 2010 Mar;8(3):517-22. doi: 10.1111/j.1538-7836.2009.03725.x. Epub 2009 Dec 15.

Pulmonary Embolism Severity Index and troponin testing for the selection of low-risk patients with acute symptomatic pulmonary embolism.

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F. Edward Hebert School of Medicine, Uniformed Services University, Bethesda, MD, USA.



The combination of the Pulmonary Embolism Severity Index (PESI) and troponin testing could help physicians identify appropriate patients with acute pulmonary embolism (PE) for early hospital discharge.


This prospective cohort study included a total of 567 patients from a single center registry with objectively confirmed acute symptomatic PE. On the basis of the PESI, each patient was classified into one of five classes (I-V). At the time of hospital admission, patients had troponin I (cTnI) levels measured. The endpoint of the study was all-cause mortality within 30 days after diagnosis. We calculated the mortality rates in four patient groups: group 1, PESI class I-II plus cTnI < 0.1 ng mL(-1); group 2, PESI classes III-V plus cTnI < 0.1 ng mL(-1); group 3, PESI classes I-II plus cTnI > or = 0.1 ng mL(-1); and group 4, PESI classes III-V plus cTnI > or = 0.1 ng mL(-1).


The study cohort had a 30-day mortality of 10% [95% confidence interval (CI), 7.6-12.5%]. Mortality rates in the four groups were 1.3%, 14.2%, 0% and 15.4%, respectively. Compared with non-elevated cTnl, the low-risk PESI had a higher negative predictive value (NPV) (98.9% vs. 90.8%) and negative likelihood ratio (NLR) (0.1 vs. 0.9) for predicting mortality. The addition of non-elevated cTnI to low-risk PESI did not improve the NPV or the NLR compared with either test alone.


Compared with cTnl testing, PESI classification more accurately identified patients with PE who are at low risk of all-cause death within 30 days of presentation.

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