Utility of the Simplified Pesi Scale in Elderly Patients with Acute Symptomatic Pulmonary Thromboembolism

Abstract

Introduction: The Simplified Pulmonary Embolism Severity Index (sPESI) scale is very helpful in identifying patients with acute symptomatic pulmonary thromboembolism (PTE) and a low risk of short-term death. The aim of this study was to evaluate the usefulness of this scale in elderly patients (>80 years).

Material and Methods: We included 3,085 elderly patients diagnosed with PTE between December 1, 2013 and January 31, 2019. We analyzed the clinical events (death from any cause, death from PTE, recurrences and major nonfatal bleeding) during the first 30 days of treatment in the group of patients with sPESI =1 and those with sPESI >1

Results: A total of 228 patients died (7.4%, 95% confidence interval (CI) 6.5%-8.4%) during the first 30 days of treatment. Mortality from any cause and from the PTE itself was significantly lower in the group of patients with sPESI =1 compared to the group of patients with sPESI >1 (3.7% vs. 9.6%, P <0.0001; 0.5% vs. 2.0%, P <0.001, respectively). There were no significant differences in the incidence of recurrences and major bleeding between the two groups (0.4% vs. 0.4%, P =1.0; 3.3% vs. 4.2%, P =0.24).

Conclusions: In elderly patients with symptomatic acute PTE, those with a sPESI = 1 had a 30-day mortality lower than those with a sPESI > 1. Although mortality from PTE itself was negligible in this group, all-cause mortality was high and related to the high comorbidity of the elderly patients.