J Korean Soc Emerg Med.  2017 Feb;28(1):71-77. 10.0000/jksem.2017.28.1.71.

Are the Cardiac Biomarkers in the Emergency Room Sufficient to Predict Adverse Events in Acute Pulmonary Embolism?

• Kim E
• Lim Y
• Jang Y
• Kim J
• Park YJ

• KMID: 2425180
• DOI: http://doi.org/10.0000/jksem.2017.28.1.71

Abstract

PURPOSE
The aim of this study is to determine whether cardiac biomarkers, such as N-terminal-proB-type natriuretic peptide (NT-proBNP), are good predictors of adverse events in acute pulmonary embolism (APE).
METHODS
We conducted a retrospective analysis of patients with APE, which was confirmed by a computed tomography in the emergency room. Patients were divided into 2 groups: the major adverse event (MAE) group and the no-MAE group. MAE was defined as one of the following occurrences: in-hospital-death, cardiopulmonary resuscitation, mechanical ventilation, vasopressors, thrombolysis, or surgical embolectomy. Blood samples were obtained during the first hour of presentation to the emergency room.
RESULTS
A total of 90 patients were included in this study. Twenty-seven patients had MAE. According to the univariate analysis, NT-proBNP, troponin I, and D-dimer plasma levels were significantly higher in the MAE group than in the noMAE group (919.8 vs. 2,131.0 ng/mL, p=0.032; 0.091 vs. 0.172 ng/mL, p=0.037; 2.43 vs. 3.74 ng/mL, p=0.049, respectively). However, according to the multivariate logistic regression, NT-proBNP was not independently associated with MAE in APE (odds ratio, 1.01; 95% confidence interval, 1.00-1.01). Conversely, troponin I was independently associated with MAE (odds ratio, 1.09; 95% confidence interval, 0.99-1.18). The NT-proBNP plasma level was not significantly different between the right ventricular dysfunction (RVD) group and the no-RVD group (p=0.178).
CONCLUSION
The NT-proBNP level, unlike the troponin I level, in the emergency room was not identified as an independent predictor of MAE in acute pulmonary embolism. Further studies of large-scale with controlled timing of blood sampling and echocardiography are required.

Keyword

Pulmonary embolism; Natriuretic peptide; Troponin I; Adverse

MeSH Terms

Biomarkers*
Cardiopulmonary Resuscitation
Echocardiography
Embolectomy
Emergencies*
Emergency Service, Hospital*
Hominidae
Humans
Logistic Models
Noma
Plasma
Pulmonary Embolism*
Respiration, Artificial
Retrospective Studies
Troponin I
Ventricular Dysfunction, Right
Biomarkers
Troponin I