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164 Association between age, troponin level and mortality in patients presenting to hospital with acute pulmonary embolism (nihr health informatics collaborative trop-pe study)
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  1. Amit Kaura1,
  2. Sahil Goswami2,
  3. Umberto Benedetto3,
  4. Abdulrahim Mulla4,
  5. Benjamin Glampson4,
  6. Vasileios Panoulas4,
  7. Jim Davies5,
  8. Kerrie Woods6,
  9. Sanjay Gautama4,
  10. Anoop D Shah7,
  11. Paul Elliott4,
  12. Harry Hemingway7,
  13. Bryan Williams7,
  14. Folkert W Asselbergs7,
  15. Narbeh Melikian8,
  16. Ajay M Shah8,
  17. Divaka Perera9,
  18. Rajesh Kharbanda6,
  19. Riyaz S Patel7,
  20. Keith M Channon6,
  21. Jennifer Quint4,
  22. Jamil Mayet4
  1. 1NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare, Hammersmith Hospital, National Heart and Lung Institute, London, GLN W12 0HS, United Kingdom
  2. 2Barts and The London School of Medicine and Dentistry, Queen Mary University of London
  3. 3NIHR Bristol Biomedical Research Centre, University of Bristol and Bristol University Hospitals
  4. 4NIHR Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare
  5. 5NIHR Oxford Biomedical Research Centre, University of Oxford and Oxford University Hospitals
  6. 6NIHR Oxford Biomedical Research Centre, University of Oxford and Oxford University Hospitals
  7. 7NIHR UCL Biomedical Research Centre, UCL and UCL Hospitals
  8. 8NIHR King’s Biomedical Research Centre, King’s College London and King’s College Hospital
  9. 9NIHR King’s Biomedical Research Centre, King’s College London and Guy’s and St Thomas’

Abstract

Background A positive cardiac troponin (cTn) is an independent predictor of short-term mortality in individuals presenting with acute pulmonary embolism (PE). However, there is limited evidence regarding the impact age has on the association between cTn levels and mortality in patients with PE. The aim of our study was to investigate the relationship between cTn level, age, and all-cause mortality, in hospitalised patients with a PE.

Methods A retrospective cohort study using the National Institute for Health Research Health Informatics Collaborative Cardiovascular dataset of all consecutive patients who had a troponin measured at five hospitals (Imperial, University College London, Oxford, King’s and Guy’s and St Thomas’) between 2010 and 2017. Patients admitted to hospital with a primary diagnosis of PE with at least one cTn measurement were included. Survival analyses were performed using multivariate Cox-Regression analyses. The peak cTn level (highest level measured), standardised to the upper limit of normal (ULN), was used for all analyses.Results1,477 patients with at least one cTn measurement and a diagnosis of PE were included. During a median follow-up of 34.8 months, there were 290 (19.6%) deaths. Elevated cTn (>1xULN) was associated with mortality with a hazard ratio (HR) of 3.29 (95% confidence interval [CI] 1.95–5.53) for 30-day mortality and 2.12 (95% CI 1.63–2.75) for 3-year mortality. Higher cTn levels were progressively associated with a higher mortality risk, reaching a maximum HR of 2.59 (95% CI 1.64–4.09) at 141xULN (Figure 1). Younger patients (<55 years), compared with those aged over 55, had the highest 3-year HR associated with a positive cTn of 2.94 (95% CI 1.48–5.82) despite having the lowest troponin levels (mean 7.01xULN) on admission (Figure 2).

Abstract 164 Figure 1

Restricted Cubic Spline demonstrating relationship between standardised peak troponin level and hazard ratio

Abstract 164 Figure 2

Mortality risk associated with troponin status and continuous troponin level stratified by age

Conclusion Elevated cTn, at all ages, is associated with an increased mortality risk in patients presenting with PE, with increasing cTn levels conferring a progressively worse long-term prognosis. Elevated cTn, no matter how small, needs to be taken seriously, particularly in young patients with an acute PE.

Conflict of Interest No conflicts of interest

  • Pulmonary embolism
  • Mortality
  • Troponin

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