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Valor Predictivo de la Proteína Transportadora de Ácidos Grasos del Miocardio y el Índice de Gravedad del Embolismo Pulmonar en Pacientes con Embolismo Pulmonar Agudo en el Servicio de Urgencias
Author(s) -
Lauque Dominique,
MaupasSchwalm Françoise,
Bounes Vincent,
Juchet Henry,
Bongard Vanina,
Roshdy Ashraf,
Botella Jean Marie,
Charpentier Sandrine
Publication year - 2014
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.12484
Subject(s) - medicine , heart type fatty acid binding protein , pulmonary embolism , emergency department , cardiology , odds ratio , troponin , natriuretic peptide , confidence interval , troponin i , receiver operating characteristic , brain natriuretic peptide , heart failure , myocardial infarction , fatty acid binding protein , biochemistry , chemistry , psychiatry , gene
Objectives Heart‐type fatty acid–binding protein (h‐ FABP ), sensitive troponins, natriuretic peptides, and clinical scores such as the Pulmonary Embolism Severity Index ( PESI ) are candidates for risk stratification of patients with acute pulmonary embolism ( PE ). The aim was to compare their respective prognostic values to predict an adverse outcome at 1 month. Methods The authors prospectively included 132 consecutive patients with confirmed acute PE. On admission to the emergency department (ED), plasma concentrations of h‐FABP, sensitive cardiac troponin I‐Ultra ( cTnI ‐Ultra), and brain natriuretic peptide (BNP) were measured and the PESI calculated in all patients. The combined 30‐day outcomes of interest were death, cardiac arrest, mechanical ventilation, use of catecholamines, and recurrence of acute PE. Results During the first 30 days, 14 (10.6%) patients suffered complications. Among the biomarkers, h‐FABP above 6 μg/L was a stronger predictor of an unfavorable outcome (odds ratio [OR] = 17.5, 95% confidence interval [CI] = 4.2 to 73.3) than BNP > 100 pg/ mL (OR = 5.7, 95% CI = 1.6 to 20.4) or cTnI ‐Ultra > 0.05 μg/L (OR = 3.4, 95% CI = 1.1 to 10.9). The PESI classified 83 of 118 patients (70.3%) with favorable outcomes and only one of 14 (7%) with adverse outcomes in low class I or II (OR = 30.8, 95% CI = 3.2 to 299.7). The areas under the receiver operating characteristic (ROC) curves (AUCs) were 0.90 (95% CI = 0.81 to 0.98) for h‐FABP, 0.89 (95% CI = 0.82 to 0.96) for PESI, 0.79 (95% CI = 0.67 to 0.90) for BNP, and 0.76 (95% CI = 0.64 to 0.87) for cTnI ‐Ultra. The combination of h‐FABP with PESI was a particularly useful prognostic indicator because none of the 79 patients (59.8%) with h‐FABP < 6 ng/ mL and PESI class < III had an adverse outcome. Conclusions h‐FABP and the PESI are superior to BNP and cTnI ‐Ultra as markers for risk stratification of patients with acute PE. The high sensitivity of their combination identified a large number of low‐risk patients in the ED.