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J Korean Soc Emerg Med > Volume 28(1); 2017 > Article
Journal of The Korean Society of Emergency Medicine 2017;28(1): 71-77.
응급실에서 채취한 심근표지자는 급성 폐색전증 환자의 예후를 예측하는데 도움이 되는가?
김은백1, 임용수1, 장연식1, 김진주1, 박용주2
1가천대학교 길병원 응급의학과
2서울대학교병원 응급의학과
Are the Cardiac Biomarkers in the Emergency Room Sufficient to Predict Adverse Events in Acute Pulmonary Embolism?
Eunbaek Kim1, Yongsu Lim1, Yeonsik Jang1, Jinjoo Kim1, Yong Joo Park2
1Department of Emergency Medicine, Gachon University Gil Medical Center, Incheon, Korea
2Seoul National University Hospital, Seoul, Korea
Correspondence  Yongsu Lim ,Tel: 032-460-3015, Fax: 032-460-3019, Email: yongem@gilhospital.com ,
Received: September 21, 2016; Revised: September 22, 2016   Accepted: October 10, 2016.  Published online: February 28, 2017.
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).
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.
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).
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.
Key words: Pulmonary embolism, Natriuretic peptide, Troponin I, Adverse
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