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

Background:Troponins (cTnI and cTnT), N‐terminal pro‐Brain Natriuretic Peptide (NT‐proBNP), myoglobin, heart‐type fatty acid‐binding protein (H‐FABP) and fibrin D‐Dimer are emergent candidates for risk stratification in pulmonary embolism (PE). Objective:To compare the respective prognostic values of biomarker with non‐massive PE to predict an adverse outcome at 3 months. Patients/Methods:One hundred and forty‐six consecutive patients with non‐massive PE were included in this multicenter prospective study. The combined outcome consisted of intensive care monitoring on admission, death or hospitalization attributable to either a PE‐related complication [defined by PE/deep vein thrombosis (DVT) relapse or major bleeding under anticoagulation] or to dyspnoea with or without chest pain during follow‐up. Results:The outcome was met in 12% of patients. In univariate analysis, a NT‐proBNP level above 300 pg/ml was the strongest predictor of unfavorable outcome with an odds ratio (OR) of 15.8 [95% confidence interval (CI): 2.05–122). ORs for the other variables were: 8.0 for D‐dimer >2000 ng/ml (95% CI: 1.1–64), 4.7 for H‐FABP >6ng/ml (95% CI:1.5–14.8), 3.5 for cTnI >0.09 ng/ml (95% CI:1.2–9.7), 3.4 for myoglobin >70 ng/ml (95% CI:0.9–12.2). Receiver operating curve (ROC) analysis indicated that NT‐proBNP was the best predictor [area under the curve (AUC) 0.84; 95%CI: 0.76–0.92; P < 0.0001] with a negative predictive value of 100% (95% CI: 91–100) at 300 pg/ml. At that cut‐off, the true negative rate for NT‐proBNP was 40%. In multivariate analysis, NT‐proBNP was the only significant independent predictors. Conclusions:NT‐proBNP appears to be a good risk stratification marker in identifying low‐risk patients with non‐massive PE who could be treated in an outpatient setting.