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

J Thromb Haemost. 2009 Mar;7(3):391-8. doi: 10.1111/j.1538-7836.2008.03260.x.


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 >6 ng/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.

Trial registration: NCT00117169.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Biomarkers
  • Fatty Acid-Binding Proteins / blood
  • Female
  • Fibrin Fibrinogen Degradation Products / analysis
  • Humans
  • Middle Aged
  • Natriuretic Peptide, Brain / blood
  • Odds Ratio
  • Peptide Fragments / blood
  • Predictive Value of Tests*
  • Prognosis
  • Prospective Studies
  • Pulmonary Embolism / diagnosis*
  • Risk Assessment
  • Troponin / blood
  • Young Adult


  • Biomarkers
  • Fatty Acid-Binding Proteins
  • Fibrin Fibrinogen Degradation Products
  • Peptide Fragments
  • Troponin
  • fibrin fragment D
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain

Associated data