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European Heart Journal Advance Access originally published online on May 23, 2005
European Heart Journal 2005 26(20):2166-2172; doi:10.1093/eurheartj/ehi336
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Biomarker-based risk assessment model in acute pulmonary embolism

Maciej Kostrubiec1, Piotr Pruszczyk1,*, Anna Bochowicz1, Ryszard Pacho2, Marcin Szulc1, Anna Kaczynska1, Grzegorz Styczynski1, Agnieszka Kuch-Wocial1, Piotr Abramczyk1, Zbigniew Bartoszewicz3, Hanna Berent1 and Krystyna Kuczynska1

1Department of Internal Medicine, Hypertension and Angiology, The Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
2Department of Radiology, The Medical University of Warsaw, Warsaw, Poland
3Department of Endocrinology, The Medical University of Warsaw, Warsaw, Poland

Received 5 December 2004; revised 20 March 2005; accepted 28 April 2005; online publish-ahead-of-print 23 May 2005.

* Corresponding author. Tel: +48 22 5992828; fax: +48 22 5991828. E-mail address: piotr.pruszczyk{at}amwaw.edu.pl

Aims Despite growing interest in biomarkers application for risk evaluation in acute pulmonary embolism (APE), no decision-making levels have been defined.

Methods and results We developed a biomarker-based risk stratification in 100 consecutive, normotensive on admission, APE patients (35 males, 65 females, 62±18 years). On admission serum NT-proBNP and cardiac troponin T (cTnT) levels were assessed and echocardiography was performed. All-cause 40-day mortality was 15% and APE mortality was 8%. In univariable analysis, cTnT>0.07 µg/L predicted all-cause mortality, hazard ratio (HR) 9.2 (95% CI: 3.3–26.1, P<0.0001), and APE mortality, HR 18.1 (95% CI: 3.6–90.2, P=0.0004); similarly, NT-proBNP>7600 ng/L predicted all-cause and APE mortalities [HR 6.7 (95% CI: 2.4–19.0, P=0.0003) and 7.3 (95% CI: 1.7–30.6, P=0.007)]. NT-proBNP<600 ng/L indicated uncomplicated outcome. Multivariable analysis revealed that cTnT>0.07 µg/L was the most significant independent predictor, whereas NT-proBNP and systemic systolic blood pressure measured on admission and echocardiographic parameters were non-significant. APE mortality in patients with NT-proBNP≥600 ng/L and cTnT≥0.07 µg/L reached 33%. NT-proBNP<600 ng/L indicated group without deaths. APE mortality for patients with NT-proBNP≥600 ng/L and cTnT<0.07 µg/L was 3.7%. Incorporation of echocardiographic data did not improve group selection.

Conclusion Simultaneous measurement of serum cTnT and NT-proBNP allows for precise APE prognosis. Normotensive patients on admission with cTnT≥0.07 µg/L and NT-proBNP≥600 ng/L are at high risk of APE mortality, whereas NTproBNP<600 ng/L indicates excellent prognosis.

Key Words: Pulmonary embolism • Brain natriuretic peptide • Troponin • Echocardiography • Prognosis • Mortality


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