Utility of Combining High-Sensitive Cardiac Troponin I and PESI Score for Risk Management in Patients with Pulmonary Embolism in the Emergency Department
Elisa Cennamo,
Gabriele Valli,
Engy Khaled Mohamed Riead,
Silvia Casalboni,
Ilaria Dafne Papasidero,
Francesca De Marco,
Anna Mariani,
Paola Pepe,
Giuseppe Santangelo,
Marina Mastracchi,
Paolo Fratini,
Giacinta Pistilli,
Pasquale Pignatelli,
Maria Pia Ruggieri,
Salvatore Di Somma
Affiliations
Elisa Cennamo
Postgraduate School of Emergency Medicine, Faculty of Medicine and Psychology, University of Rome La Sapienza, 00185 Rome, Italy
Gabriele Valli
Emergency Department, San Giovanni Addolorata Hospital, 00184 Rome, Italy
Engy Khaled Mohamed Riead
Postgraduate School of Emergency Medicine, Faculty of Medicine and Psychology, University of Rome La Sapienza, 00185 Rome, Italy
Silvia Casalboni
Postgraduate School of Emergency Medicine, Faculty of Medicine and Psychology, University of Rome La Sapienza, 00185 Rome, Italy
Ilaria Dafne Papasidero
Postgraduate School of Emergency Medicine, Faculty of Medicine and Psychology, University of Rome La Sapienza, 00185 Rome, Italy
Francesca De Marco
Emergency Department, San Giovanni Addolorata Hospital, 00184 Rome, Italy
Anna Mariani
Postgraduate School of Emergency Medicine, Faculty of Medicine and Psychology, University of Rome La Sapienza, 00185 Rome, Italy
Paola Pepe
Postgraduate School of Emergency Medicine, Faculty of Medicine and Psychology, University of Rome La Sapienza, 00185 Rome, Italy
Giuseppe Santangelo
Postgraduate School of Emergency Medicine, Faculty of Medicine and Psychology, University of Rome La Sapienza, 00185 Rome, Italy
Marina Mastracchi
Postgraduate School of Emergency Medicine, Faculty of Medicine and Psychology, University of Rome La Sapienza, 00185 Rome, Italy
Paolo Fratini
Postgraduate School of Emergency Medicine, Faculty of Medicine and Psychology, University of Rome La Sapienza, 00185 Rome, Italy
Giacinta Pistilli
Postgraduate School of Emergency Medicine, Faculty of Medicine and Psychology, University of Rome La Sapienza, 00185 Rome, Italy
Pasquale Pignatelli
Department of Internistic, Anesthesiologic and Cardiovascular Clinical Sciences, University of Rome La Sapienza, 00185 Rome, Italy
Maria Pia Ruggieri
Emergency Department, San Giovanni Addolorata Hospital, 00184 Rome, Italy
Salvatore Di Somma
Postgraduate School of Emergency Medicine, Faculty of Medicine and Psychology, University of Rome La Sapienza, 00185 Rome, Italy
Background and Objectives: Pulmonary embolism (PE) has a major burden of morbidity and mortality, consequently the need for a prompt risk stratification for these subjects is crucial. In order to evaluate the risk management and final disposition of patients with PE in the Emergency Department (ED), we conducted a study that was divided in two phases: Phase I retrospective study (RS), Phase II prospective study (PS). Materials and Methods: In Phase I, 291 patients were enrolled while in Phase II, 83 subjects were evaluated. In both study phases, the enrolled subjects were analyzed for final disposition in ED using PESI score, right ventricle (RV) imaging, and high-sensitive cardiac troponin I (hs-cTnI) data. The RS patients were divided into low risk and high risk according to the sPESI score, while PS patients were grouped in low, intermediate, and high risk classes according to PESI score. In both study phases, all the studied patients were further divided into negative (hs-cTnI−) or positive (hs-cTnI+) groups according to hs-cTnI levels within normal or above cutoff values, respectively. For all enrolled subjects, CT pulmonary angiography was analyzed to assess the RV/LV diameter and volume ratio as an indicator of RV involvement. Results: In both RS and PS phases, hs-cTnI+ group showed a higher PESI score. Nevertheless, a significant percentage of hs-cTnI+ patients resulted to be in the low-risk PESI class. Patients with a positive RV/LV ratio were more likely to have a hs-cTnI+ (p < 0.01), while among those with a negative ratio, 24 to 32% showed as hs-cTnI+. In the hs-cTnI+ group from both study phases, patients were more likely to be admitted in an ICU (RR 3.7, IC: 2.1–6.5). Conclusions: In conclusion, in patients with PE in the ED compared PESI score alone, the combination of hs-cTnI and PESI seems to be of greater utility in improving risk stratification and final disposition decision-making.
