Prevalence of Low High-Sensitivity Troponin in Pulmonary Embolism: Insights from the RACE-IT Trial
Recommended Citation
Hawatian K, Cook B, Gunaga S, Emakhu JO, Krupp SS, Klausner HA, Miller J, Almri Y, Perrotta G, Tuttle JE, Morton TJ, McCord J. Prevalence of Low High-Sensitivity Troponin in Pulmonary Embolism: Insights from the RACE-IT Trial. Acad Emerg Med 2025; 32(S1):20.
Document Type
Conference Proceeding
Publication Date
5-13-2025
Publication Title
Acad Emerg Med
Keywords
D dimer, troponin, adult, cohort analysis, conference abstract, controlled study, diagnostic value, electrocardiogram, electrocardiography, female, human, limit of quantitation, lung embolism, major clinical study, male, middle aged, prevalence, secondary analysis
Abstract
Background and Objectives: As the use of high-sensitivity cardiac troponin (hs-cTn) continues to expand, hs-cTn is frequently used to assess patients diagnosed with acute pulmonary embolism (PE). We sought to quantify the prevalence of hs-cTn below the limit of quantitation (LoQ) and measure its diagnostic value. Methods: We performed a secondary analysis of the RACE-IT trial, a cluster-randomized implementation trial of hs-cTn performed across nine diverse EDs. Patients who had cardiopulmonary symptoms necessitating evaluation with cTn testing and an electrocardiogram were eligible. We excluded those with trauma or age <22 years. The analysis assessed the relationship between hs-cTnI and the outcome of imaging confirmed PE. The LoQ for the hs-cTnI assay was 4 ng/L. Statistical methods included univariate and multivariable logistic or linear regression where applicable and report odds ratios (OR) with 95% confidence intervals (CI). Results: There were 32,609 patients in the trial, 18,705 (57.4%) females, and the mean age was 58.0 (18.0) years. 6,142 (18.8%) of patients had CT chest imaging performed. 176 (0.54%) patients were diagnosed with PE. 8,556 patients had d-dimer testing, of whom 4,107 had abnormal elevation. The median hs-cTnI was 4 in those with PE (interquartile [IQR] 4-7) and 4 in those without PE (IQR 4-6). 97 (55.1%) PE patients had a hs-cTnI < 4 ng/L vs. 20,330 (62.7%) patients without PE. While by itself, a hs-cTnI < 4 ng/L was associated with reduced odds of PE (OR 0.73, 95% CI 0.54-0.98) when adjusted for sex, age, race, and d-dimer, this relationship was not statistically significant (adjusted OR 0.81, 95% CI 0.58-1.11). Conclusion: In patients with acute PE, hs-cTnI below the LoQ is common and is not associated with reduced odds of PE.
Volume
32
Issue
S1
First Page
20
