Yugo Yamashita1, Takeshi Morimoto2, Hidewo Amano3, Toru Takase4, Seiichi Hiramori5, Kitae Kim6, Maki Oi7, Masaharu Akao8, Yohei Kobayashi9, Mamoru Toyofuku10, Toshiaki Izumi11, Tomohisa Tada12, Po-Min Chen13, Koichiro Murata14, Yoshiaki Tsuyuki15, Syunsuke Saga16, Tomoki Sasa17, Jiro Sakamoto18, Minako Kinoshita19, Kiyonori Togi20, Hiroshi Mabuchi21, Kensuke Takabayashi22, Hiroki Shiomi1, Takao Kato1, Takeru Makiyama1, Koh Ono1, Takeshi Kimura1. 1. Department of Cardiovascular Medicine, Kyoto University, Japan. 2. Department of Clinical Epidemiology, Hyogo College of Medicine, Japan. 3. Department of Cardiovascular Medicine, Kurashiki Central Hospital, Japan. 4. Department of Cardiology, Kinki University Hospital, Japan. 5. Department of Cardiology, Kokura Memorial Hospital, Japan. 6. Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan. 7. Department of Cardiology, Japanese Red Cross Otsu Hospital, Japan. 8. Department of Cardiology, National Hospital Organization Kyoto Medical Center, Japan. 9. Department of Cardiovascular Center, Osaka Red Cross Hospital, Japan. 10. Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Japan. 11. Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Japan. 12. Department of Cardiology, Shizuoka General Hospital, Japan. 13. Department of Cardiology, Osaka Saiseikai Noe Hospital, Japan. 14. Department of Cardiology, Shizuoka City Shizuoka Hospital, Japan. 15. Division of Cardiology, Shimada Municipal Hospital, Japan. 16. Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Japan. 17. Department of Cardiology, Kishiwada City Hospital, Japan. 18. Department of Cardiology, Tenri Hospital, Japan. 19. Department of Cardiology, Nishikobe Medical Center, Japan. 20. Division of Cardiology, Kinki University Faculty of Medicine, Japan. 21. Department of Cardiology, Koto Memorial Hospital, Japan. 22. Department of Cardiology, Hirakata Kohsai Hospital, Japan.
Abstract
BACKGROUND: The simplified pulmonary embolism severity index (sPESI) score has been reported to be useful in predicting 30-day mortality for patients with pulmonary embolism, which helps the identification of low-risk patients for early hospital discharge or home treatment. However, therapeutic decision-making should also be based on the risks of adverse events other than mortality. METHODS: The COMMAND VTE Registry is a multicentre registry enrolling consecutive patients with acute symptomatic venous thromboembolism in Japan between January 2010 and August 2014, and the current study population consisted of 1715 patients with pulmonary embolism. We calculated the sPESI score for each patient, and compared 30-day rates of mortality, recurrent venous thromboembolism and major bleeding between sPESI scores of 0 and 1 or greater. RESULTS: Patients with a sPESI score of 0 accounted for 383 (22%) patients, and 110 (6.4%) patients died within 30 days. The cumulative 30-day incidence of mortality was lower in patients with a sPESI score of 0 than those with a sPESI score of 1 or greater (0.5% vs. 8.1%, log rank P<0.001). There was no significant difference in the cumulative 30-day incidence of recurrent venous thromboembolism between patients with a sPESI score of 0 and 1 or greater (1.3% vs. 2.8%, log rank P=0.11). The cumulative 30-day incidence of major bleeding was lower in patients with a sPESI score of 0 than those with a sPESI score of 1 or greater (1.1% vs. 4.0%, log rank P=0.005). CONCLUSIONS: In patients with a sPESI score of 0, the 30-day mortality, recurrent venous thromboembolism and major bleeding rates were reasonably low. The sPESI score could be useful to identify candidates for early hospital discharge or home treatment.
BACKGROUND: The simplified pulmonary embolism severity index (sPESI) score has been reported to be useful in predicting 30-day mortality for patients with pulmonary embolism, which helps the identification of low-risk patients for early hospital discharge or home treatment. However, therapeutic decision-making should also be based on the risks of adverse events other than mortality. METHODS: The COMMAND VTE Registry is a multicentre registry enrolling consecutive patients with acute symptomatic venous thromboembolism in Japan between January 2010 and August 2014, and the current study population consisted of 1715 patients with pulmonary embolism. We calculated the sPESI score for each patient, and compared 30-day rates of mortality, recurrent venous thromboembolism and major bleeding between sPESI scores of 0 and 1 or greater. RESULTS: Patients with a sPESI score of 0 accounted for 383 (22%) patients, and 110 (6.4%) patients died within 30 days. The cumulative 30-day incidence of mortality was lower in patients with a sPESI score of 0 than those with a sPESI score of 1 or greater (0.5% vs. 8.1%, log rank P<0.001). There was no significant difference in the cumulative 30-day incidence of recurrent venous thromboembolism between patients with a sPESI score of 0 and 1 or greater (1.3% vs. 2.8%, log rank P=0.11). The cumulative 30-day incidence of major bleeding was lower in patients with a sPESI score of 0 than those with a sPESI score of 1 or greater (1.1% vs. 4.0%, log rank P=0.005). CONCLUSIONS: In patients with a sPESI score of 0, the 30-day mortality, recurrent venous thromboembolism and major bleeding rates were reasonably low. The sPESI score could be useful to identify candidates for early hospital discharge or home treatment.
Authors: Paul Gressenberger; Florian Posch; Moritz Pechtold; Katharina Gütl; Viktoria Muster; Philipp Jud; Jakob Riedl; Günther Silbernagel; Ewald Kolesnik; Johannes Schmid; Reinhard B Raggam; Marianne Brodmann; Thomas Gary Journal: Front Cardiovasc Med Date: 2022-02-07