RT Journal Article
SR Electronic
T1 Acute pulmonary embolism: mortality prediction by the 2014 European Society of Cardiology risk stratification model
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 780
OP 786
DO 10.1183/13993003.00024-2016
VO 48
IS 3
A1 Becattini, Cecilia
A1 Agnelli, Giancarlo
A1 Lankeit, Mareike
A1 Masotti, Luca
A1 Pruszczyk, Piotr
A1 Casazza, Franco
A1 Vanni, Simone
A1 Nitti, Cinzia
A1 Kamphuisen, Pieter
A1 Vedovati, Maria Cristina
A1 De Natale, Maria Grazia
A1 Konstantinides, Stavros
YR 2016
UL http://erj.ersjournals.com/content/48/3/780.abstract
AB The European Society of Cardiology (ESC) has proposed an updated risk stratification model for death in patients with acute pulmonary embolism based on clinical scores (Pulmonary Embolism Severity Index (PESI) or simplified PESI (sPESI)), right ventricle dysfunction (RVD) and elevated serum troponin (2014 ESC model).We assessed the ability of the 2014 ESC model to predict 30-day death after acute pulmonary embolism. Consecutive patients with symptomatic, confirmed pulmonary embolism included in prospective cohorts were merged in a collaborative database. Patients’ risk was classified as high (shock or hypotension), intermediate-high (RVD and elevated troponin), intermediate-low (RVD or increased troponin or none) and low (sPESI 0). Study outcomes were death and pulmonary embolism-related death at 30 days.Among 906 patients (mean±sd age 68±16, 489 females), death and pulmonary embolism-related death occurred in 7.2% and 4.1%, respectively. Death rate was 22% in “high-risk” (95% CI 14.0–29.8), 7.7% in “intermediate-high-risk” (95% CI 4.5–10.9) and 6.0% in “intermediate-low-risk” patients (95% CI 3.4–8.6). One of the 196 “low-risk” patients died (0.5%, 95% CI 0–1.0; negative predictive value 99.5%).By using the 2014 ESC model, RVD or troponin tests would be avoided in about 20% of patients (sPESI 0), preserving a high negative predictive value. Risk stratification in patients at intermediate risk requires further improvement.2014 ESC model in PE accurately identifies low-risk patients; further improvement for intermediate risk is needed http://ow.ly/10b3Qg