[Determinants of prognosis in acute pulmonary embolism: the role of serum troponins].

In-hospital mortality in patients with acute pulmonary embolism ranges between about 1% and over 30%. Due to a particularly high mortality, hemodynamically unstable patients with pulmonary embolism should receive thrombolytic treatment. The role of thrombolytic treatment in hemodynamically stable patients with pulmonary embolism is controversial and should be restricted to those at high risk for in-hospital mortality. Prognostic stratification is crucial in hemodynamically stable patients as mortality in this group ranges between 1 and 10%. Serum troponin levels have been shown to be associated with in-hospital mortality and clinical deterioration. Studies on the prognostic value of serum troponin in patients with acute pulmonary embolism have been included in a meta-analysis that shows a 5-fold in hospital mortality in patients with high troponin compared to those with normal troponin levels. The prognostic value of elevated serum troponin levels have also been shown in studies including only hemodynamically stable patients with pulmonary embolism. Future studies will evaluate the clinical benefit of thrombolytic treatment in hemodynamically stable patients with acute pulmonary embolism at high risk for adverse outcome.