Mareike Lankeit1, Vicente Gómez2, Carolin Wagner3, Drahomir Aujesky4, Mónica Recio5, Sem Briongos5, Col Lisa K Moores6, Roger D Yusen7, Stavros Konstantinides8, David Jiménez9. 1. Department of Cardiology and Pulmonology, University of Göttingen, Göttingen, Germany. 2. Medicine Department, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain. 3. Respiratory Department, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain. 4. Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland. 5. Cardiology Department, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain. 6. F. Edward Hebert School of Medicine, Uniformed Services University, Bethesda, MD. 7. Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences, Washington University School of Medicine, St. Louis, MO. 8. Department of Cardiology and Pulmonology, University of Göttingen, Göttingen, Germany; Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece. 9. Respiratory Department, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain. Electronic address: djc_69_98@yahoo.com.
Abstract
BACKGROUND: This study aimed to assess the performance of two prognostic models-the European Society of Cardiology (ESC) model and the simplified Pulmonary Embolism Severity Index (sPESI)-in predicting short-term mortality in patients with pulmonary embolism (PE). METHODS: We compared the test characteristics of the ESC model and the sPESI for predicting 30-day outcomes in a cohort of 526 patients with objectively confirmed PE. The primary end point of the study was all-cause mortality. The secondary end point included all-cause mortality, nonfatal symptomatic recurrent VTE, or nonfatal major bleeding. RESULTS: Overall, 40 of 526 patients died (7.6%; 95% CI, 5.3%-9.9%) during the first month of follow-up. The sPESI classified fewer patients as low risk (31% [165 of 526], 95% CI, 27%-35%) compared with the ESC model (39% [207 of 526], 95% CI, 35% to 44%; P < .01). Importantly however, low-risk patients based on the sPESI had no 30-day mortality compared with 3.4% (95% CI, 0.9-5.8) in low-risk patients by the ESC model. The secondary end point occurred in 1.8% of patients in the sPESI low-risk and 5.8% in the ESC low-risk group (difference, 4.0 percentage points; 95% CI, 0.2-7.8). The prognostic ability of the ESC model remained significant in the subgroup of patients at high-risk according to the sPESI model (OR 1.95, 95% CI, 1.41 to 2.71, P < .001). CONCLUSIONS: Both the sPESI and the ESC model successfully predict 30-day mortality after acute symptomatic PE, but exclusion of an adverse early outcome does not appear to require routine imaging procedures or laboratory biomarker testing.
BACKGROUND: This study aimed to assess the performance of two prognostic models-the European Society of Cardiology (ESC) model and the simplified Pulmonary Embolism Severity Index (sPESI)-in predicting short-term mortality in patients with pulmonary embolism (PE). METHODS: We compared the test characteristics of the ESC model and the sPESI for predicting 30-day outcomes in a cohort of 526 patients with objectively confirmed PE. The primary end point of the study was all-cause mortality. The secondary end point included all-cause mortality, nonfatal symptomatic recurrent VTE, or nonfatal major bleeding. RESULTS: Overall, 40 of 526 patients died (7.6%; 95% CI, 5.3%-9.9%) during the first month of follow-up. The sPESI classified fewer patients as low risk (31% [165 of 526], 95% CI, 27%-35%) compared with the ESC model (39% [207 of 526], 95% CI, 35% to 44%; P < .01). Importantly however, low-risk patients based on the sPESI had no 30-day mortality compared with 3.4% (95% CI, 0.9-5.8) in low-risk patients by the ESC model. The secondary end point occurred in 1.8% of patients in the sPESI low-risk and 5.8% in the ESC low-risk group (difference, 4.0 percentage points; 95% CI, 0.2-7.8). The prognostic ability of the ESC model remained significant in the subgroup of patients at high-risk according to the sPESI model (OR 1.95, 95% CI, 1.41 to 2.71, P < .001). CONCLUSIONS: Both the sPESI and the ESC model successfully predict 30-day mortality after acute symptomatic PE, but exclusion of an adverse early outcome does not appear to require routine imaging procedures or laboratory biomarker testing.
Authors: Agnieszka Krajewska; Katarzyna Ptaszynska-Kopczynska; Izabela Kiluk; Urszula Kosacka; Robert Milewski; Jacek Krajewski; Wlodzimierz Jerzy Musial; Bozena Sobkowicz Journal: Biomed Res Int Date: 2017-02-09 Impact factor: 3.411