However, myocardial infarctions also have been reported6–7 in patients with APE and healthy coronary arteries. Moreover, we found no differences in the incidence of CAD among troponin-positive and troponin-negative groups, survivors, or nonsurvivors. It should be underlined that in our study detectable serum troponin levels predicted a fatal outcome and a complicated clinical course (ie, at least one of the following in-hospital events: death; thrombolysis; cardiopulmonary resuscitation; and use of IV catecholamine agents), while the presence of CAD did not. The in-hospital mortality rate in patients who experience submassive APEs has been reported to reach approximately 15%.9 Therefore, it is very important to identify among these patients a high-risk group that should be closely monitored and that may require thrombolysis. Interestingly, all eight in-hospital deaths that were observed in our study occurred in the troponin-positive group (in-hospital mortality rate, 25%).5 Thus, we believe that patients with signs of myocardial injury should be considered as potential candidates for aggressive therapy. However, a multicenter, prospective, randomized trial is needed to address the clinical value biomarkers and to define their optimal levels in a management strategy of patients with submassive APEs.