title: Comparison of Cardiac and Non-Cardiac Biomarkers for Risk Stratification in Elderly Patients with Non-Massive Pulmonary Embolism.
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.
  
  
  
  ClinicalTrials.gov NCT00973596.
authors.affiliation: Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Vuilleumier
authors.affiliation: Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
authors.forename: Aurélien
authors.initials: A
authors.lastname: Simona
authors.affiliation: Division of General Internal Medicine, Bern University Hospital and University of Bern, Bern, Switzerland.|Service of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.
authors.forename: Marie
authors.initials: M
authors.lastname: Méan
authors.affiliation: CTU Bern, Department of Clinical Research and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Limacher
authors.affiliation: Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
authors.forename: Pierre
authors.initials: P
authors.lastname: Lescuyer
authors.affiliation: Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.|Clinique de la Colline, Geneva, Switzerland.
authors.forename: Eric
authors.initials: E
authors.lastname: Gerstel
authors.affiliation: Division of Angiology and Haemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
authors.forename: Henri
authors.initials: H
authors.lastname: Bounameaux
authors.affiliation: Division of General Internal Medicine, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Drahomir
authors.initials: D
authors.lastname: Aujesky
authors.affiliation: Division of Angiology and Haemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Righini
mesh_terms: D053607:Adrenomedullin / Q000097:blood*; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000378:metabolism; D016019:Survival Analysis; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; D010446:Peptide Fragments; D011498:Protein Precursors; D020107:Troponin T; C048197:copeptins; C574167:mid-regional pro-adrenomedullin, human; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D053607:Adrenomedullin