Carlo Bova1, Simone Vanni2, Paolo Prandoni3, Fulvio Morello4, Francesco Dentali5, Enrico Bernardi6, Nicola Mumoli7, Eugenio Bucherini8, Sofia Barbar9, Claudio Picariello10, Iolanda Enea11, Raffaele Pesavento12, Fabrizio Bottino13, David Jiménez14. 1. Department of Internal Medicine, Azienda Ospedaliera (Coordinating Center), Cosenza, Italy. Electronic address: c.bova@aocs.it. 2. Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy. 3. Department of Cardiovascular Sciences, Vascular Medicine Unit, University of Padua, Italy. 4. Emergency Department, A.O.U. Città della Salute e della Scienza di Torino, Ospedale Molinette, Torino, Italy. 5. Department of Clinical and Experimental Medicine, Insubria University, Varese, Italy. 6. Department of Emergency Medicine, ULSS n.7, Conegliano, TV, Italy. 7. Department of Internal Medicine, Ospedale Civile Livorno, Italy. 8. Angiology Unit, Civic Hospital Faenza - Ravenna, Italy. 9. Department of Internal and Emergency Medicine, Civic Hospital of Camposampiero (PD), Italy. 10. Unit of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy. 11. Emergency Care Department, Anna e S. Sebastiano Hospital, Caserta, Italy. 12. Department of Internal Medicine, University of Padua, Italy. 13. Emergency Department, ASL 8, Arezzo, Italy. 14. Respiratory Department, Ramón y Cajal Hospital, IRYCIS, Alcalá de Henares University, Madrid, Spain.
Abstract
BACKGROUND: The Bova score has shown usefulness in the identification of intermediate-high risk patients with acute pulmonary embolism (PE), but lacks prospective validation. The aim of this study was to prospectively validate the Bova score in different settings from the original derivation cohort. METHODS: Consecutive, normotensive patients with acute PE recruited at 13 academic or general hospitals were stratified, using their baseline data, into the three Bova risk stages (I-III). The primary outcome was the 30-day composite of PE-related mortality, hemodynamic collapse and non-fatal PE recurrences in the three risk categories. RESULTS: In the study period, 639 patients were enrolled. The primary end point occurred in 45 patients (7.0%; 95% Confidence Intervals, 5.2%-9.3%). Risk stage correlated with the PE-related complication rate (stage I, 2.9%; stage II, 17%; stage III, 27%). Patients classified as stage III by the Bova score had a 6.5-fold increased risk for adverse outcomes (3.1-13.5, p < 0.001) compared with stages I and II combined. Rescue thrombolysis increased from stage I to stage III (0.6%, 12% and 15% respectively). All-cause mortality (5.3%) did not substantially differ among the stages. CONCLUSIONS: The Bova score accurately stratifies normotensive patients with acute PE into stages of increasing risk of 30-day PE-related complications.
BACKGROUND: The Bova score has shown usefulness in the identification of intermediate-high risk patients with acute pulmonary embolism (PE), but lacks prospective validation. The aim of this study was to prospectively validate the Bova score in different settings from the original derivation cohort. METHODS: Consecutive, normotensive patients with acute PE recruited at 13 academic or general hospitals were stratified, using their baseline data, into the three Bova risk stages (I-III). The primary outcome was the 30-day composite of PE-related mortality, hemodynamic collapse and non-fatal PE recurrences in the three risk categories. RESULTS: In the study period, 639 patients were enrolled. The primary end point occurred in 45 patients (7.0%; 95% Confidence Intervals, 5.2%-9.3%). Risk stage correlated with the PE-related complication rate (stage I, 2.9%; stage II, 17%; stage III, 27%). Patients classified as stage III by the Bova score had a 6.5-fold increased risk for adverse outcomes (3.1-13.5, p < 0.001) compared with stages I and II combined. Rescue thrombolysis increased from stage I to stage III (0.6%, 12% and 15% respectively). All-cause mortality (5.3%) did not substantially differ among the stages. CONCLUSIONS: The Bova score accurately stratifies normotensive patients with acute PE into stages of increasing risk of 30-day PE-related complications.
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