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Cardiac biomarkers for risk stratification in non-massive pulmonary embolism: a multicenter prospective study

N Vuilleumier1, G Le Gal, F Verschuren

  • 1Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland. nicolas.vuilleumier@hcuge.ch

Journal of Thrombosis and Haemostasis : JTH
|December 18, 2008
PubMed

Insights

N-terminal pro-Brain Natriuretic Peptide (NT-proBNP) is the strongest predictor of adverse outcomes in non-massive pulmonary embolism (PE). Elevated NT-proBNP levels can identify low-risk PE patients suitable for outpatient treatment.

Area of Science:

  • Cardiology
  • Pulmonary Medicine
  • Biomarker Research

Background:

  • Pulmonary embolism (PE) risk stratification utilizes emergent biomarkers.
  • Candidates include troponins (cTnI, cTnT), N-terminal pro-Brain Natriuretic Peptide (NT-proBNP), myoglobin, heart-type fatty acid-binding protein (H-FABP), and fibrin D-Dimer.

Purpose of the Study:

  • To compare the prognostic values of various biomarkers.
  • To predict adverse outcomes at 3 months in patients with non-massive PE.

Main Methods:

  • A multicenter prospective study included 146 patients with non-massive PE.
  • The combined outcome included intensive care monitoring, death, or PE-related hospitalization.
  • Follow-up assessed PE/DVT relapse, major bleeding, or PE-related dyspnea.

Main Results:

  • NT-proBNP above 300 pg/ml was the strongest univariate predictor (OR 15.8).
  • NT-proBNP demonstrated the best predictive performance (AUC 0.84) with 100% negative predictive value.
  • NT-proBNP was the sole significant independent predictor in multivariate analysis.

Conclusions:

  • NT-proBNP is a valuable risk stratification marker for non-massive PE.
  • It effectively identifies low-risk patients.
  • Outpatient management may be suitable for these patients.
Abstract

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