Cardiac biomarkers and clinical scores for risk stratification in elderly patients with non‐high‐risk pulmonary embolism. (13th November 2014)

• Record Type: Journal Article
• Authors: Vuilleumier, N.; Limacher, A.; Méan, M.; Choffat, J.; Lescuyer, P.; Bounameaux, H.; Aujesky, D.; Righini, M.
• Is Part Of: Journal of internal medicine. Volume 277:Number 6(2015:Jun.)
• Page Start: 707
• Page End: 716
• Publication Date: 2014-11-13
• Subjects: Internal medicine -- Periodicals; Medicine -- Periodicals; 616
• DOI: 10.1111/joim.12316
• Languages: English
• ISSNs: 0954-6820

Abstract

<abstract abstract-type="main" id="joim12316-abs-0001"> <title>Abstract</title> <sec id="joim12316-sec-0001" sec-type="section"> <title>Objective</title> <p>To determine the prognostic accuracy of cardiac biomarkers alone and in combination with clinical scores in elderly patients with non‐high‐risk pulmonary embolism (PE).</p> </sec> <sec id="joim12316-sec-0002" sec-type="section"> <title>Design</title> <p>Ancillary analysis of a Swiss multicentre prospective cohort study.</p> </sec> <sec id="joim12316-sec-0003" sec-type="section"> <title>Subjects</title> <p>A total of 230 patients aged ≥65 years with non‐high‐risk PE.</p> </sec> <sec id="joim12316-sec-0004" sec-type="section"> <title>Main outcome measures</title> <p>The study end‐point was a composite of PE‐related complications, defined as PE‐related death, recurrent venous thromboembolism or major bleeding during a follow‐up of 30 days. The prognostic accuracy of the Pulmonary Embolism Severity Index (PESI), the Geneva Prognostic Score (GPS), the precursor of brain natriuretic peptide (NT‐proBNP) and high‐sensitivity cardiac troponin T (hs‐cTnT) was determined using sensitivity, specificity, predictive values, receiver operating characteristic (ROC) curve analysis, logistic regression and reclassification statistics.</p> </sec> <sec id="joim12316-sec-0005" sec-type="section"> <title>Results</title> <p>The overall complication rate during follow‐up was 8.7%. hs‐cTnT achieved the highest prognostic accuracy [area under the ROC curve: 0.75, 95% confidence interval (CI): 0.63–0.86, <italic>P </italic><<italic> </italic>0.001). At the predefined cut‐off values, the negative predictive values of the biomarkers were above 95%. For levels above the cut‐off, the risk of complications increased fivefold for hs‐cTnT [odds ratio (OR): 5.22, 95% CI: 1.49–18.25] and 14‐fold for NT‐proBNP (OR: 14.21, 95% CI: 1.73–116.93) after adjustment for both clinical scores and renal function. Reclassification statistics indicated that adding hs‐cTnT to the GPS or the PESI significantly improved the prognostic accuracy of both clinical scores.</p> </sec> <sec id="joim12316-sec-0006" sec-type="section"> <title>Conclusion</title> <p>In elderly patients with nonmassive PE, NT‐proBNP or hs‐cTnT could be an adequate alternative to clinical scores for identifying low‐risk individuals suitable for outpatient management.</p> </sec> </abstract>