Comparison of Cardiac and Non-Cardiac Biomarkers for Risk Stratification in Elderly Patients with Non-Massive Pulmonary Embolism

Nicolas Vuilleumier, Aurélien Simona, Marie Méan, Andreas Limacher, Pierre Lescuyer, Eric Gerstel, Henri Bounameaux, Drahomir Aujesky, Marc Righini, Nicolas Vuilleumier, Aurélien Simona, Marie Méan, Andreas Limacher, Pierre Lescuyer, Eric Gerstel, Henri Bounameaux, Drahomir Aujesky, Marc Righini

Abstract

Biomarkers unrelated to myocardial necrosis, such as cystatin C, copeptin, and mid-regional pro-adrenomedullin (MR-proADM), showed promise for cardiovascular risk prediction. Knowing whether they are comparable to cardiac biomarkers such as high-sensitive cardiac-troponin T (hs-cTnT) or N-terminal pro-Brain natriuretic peptide (NT-proBNP) in elderly patients with acute non-massive pulmonary embolism (NMPE) remains elusive. This study aims at comparing the prognostic accuracy of cardiac and non-cardiac biomarkers in patients with NMPE aged ≥65 years over time. In the context of the SWITCO65+ cohort, we evaluated 227 elderly patients with an available blood sample taken within one day from diagnosis. The primary study endpoint was defined as PE-related mortality and the secondary endpoint as PE-related complications. The biomarkers' predictive ability at 1, 3, 12 and 24 months was determined using C-statistics and Cox regression. For both study endpoints, C-statistics (95% confidence interval) were stable over time for all biomarkers, with the highest value for hs-cTnT, ranging between 0.84 (0.68-1.00) and 0.80 (0.70-0.90) for the primary endpoint, and between 0.74 (0.63-0.86) and 0.65 (0.57-0.73) for the secondary endpoint. For both study endpoints, cardiac biomarkers were found to be independently associated with risk, NT-proBNP displaying a negative predictive value of 100%. Among non-cardiac biomarkers, only copeptin and MR-proADM were independent predictors of PE-related mortality but they were not independent predictors of PE-related complications, and displayed lower negative predictive values. In elderly NMPE patients, cardiac biomarkers appear to be valuable prognostic to identify very low-risk individuals.

Trial registration: ClinicalTrials.gov NCT00973596.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Cumulative incidence of PE-related mortality…
Fig 1. Cumulative incidence of PE-related mortality by level of NT-proBNP (left panel) and hs-cTnT (right panel).
High versus low levels are based on pre-specified cut-offs (>300 pg/mL for NT-proBNP and >14 ng/L for hs-cTnT).
Fig 2. Cumulative incidence of PE-related complications…
Fig 2. Cumulative incidence of PE-related complications by level of NT-proBNP (left panel) and hs-cTnT (right panel).
High versus low levels are based on pre-specified cut-offs (>300 pg/mL for NT-proBNP and >14 ng/L for hs-cTnT).

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