Cecilia Becattini1, Giorgio Maraziti1, David R Vinson2, Austin C C Ng3, Paul L den Exter4, Benoit Côté5, Simone Vanni6, Rami Doukky7, Danai Khemasuwan8, Anthony J Weekes9, Thiago Horta Soares10, Savas Ozsu11, Hernan Polo Friz12, Serhat Erol13, Giancarlo Agnelli1, David Jiménez14,15. 1. Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Ospedale Santa Maria della Misericordia, Via G. Dottori 1, 06129 Perugia, Italy. 2. Department of Emergency Medicine, The Permanente Medical Group and the Kaiser Permanente Division of Research, Oakland, CA, USA. 3. Cardiology Department, Concord Hospital, The University of Sydney, Concord, NSW, Australia. 4. Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands. 5. Département de Médecine Interne, Hôpital de l'Enfant-Jésus du CHU de Québec, Université Laval, Québec, Canada. 6. Emergency Medicine Unit, Empoli, Azienda Usl Toscana Centro, Italy. 7. Division of Cardiology, Cook County Health, Chicago, IL, USA. 8. Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University, Richmond, VA, USA. 9. Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC, USA. 10. Internal Medicine Division, Rede Mater Dei de Saúde, Belo Horizonte, Minas Gerais, Brazil. 11. Department of Pulmonary Medicine, School of Medicine, Karadeniz Technical University, Trabzon, Turkey. 12. Internal Medicine Division, Medical Department, Vimercate Hospital, Vimercate, Italy. 13. University of Ankara School of Medicine, Pulmonary Diseases Department, Ankara, Turkey. 14. Respiratory Department, Ramón y Cajal Hospital and Universidad de Alcalá (IRYCIS), Madrid, Spain. 15. CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
Abstract
AIMS: Patients with acute pulmonary embolism (PE) at low risk for short-term death are candidates for home treatment or short-hospital stay. We aimed at determining whether the assessment of right ventricle dysfunction (RVD) or elevated troponin improves identification of low-risk patients over clinical models alone. METHODS AND RESULTS: Individual patient data meta-analysis of studies assessing the relationship between RVD or elevated troponin and short-term mortality in patients with acute PE at low risk for death based on clinical models (Pulmonary Embolism Severity Index, simplified Pulmonary Embolism Severity Index or Hestia). The primary study outcome was short-term death defined as death occurring in hospital or within 30 days. Individual data of 5010 low-risk patients from 18 studies were pooled. Short-term mortality was 0.7% [95% confidence interval (CI) 0.4-1.3]. RVD at echocardiography, computed tomography or B-type natriuretic peptide (BNP)/N-terminal pro BNP (NT-proBNP) was associated with increased risk for short-term death (1.5 vs. 0.3%; OR 4.81, 95% CI 1.98-11.68), death within 3 months (1.6 vs. 0.4%; OR 4.03, 95% CI 2.01-8.08), and PE-related death (1.1 vs. 0.04%; OR 22.9, 95% CI 2.89-181). Elevated troponin was associated with short-term death (OR 2.78, 95% CI 1.06-7.26) and death within 3 months (OR 3.68, 95% CI 1.75-7.74). CONCLUSION: RVD assessed by echocardiography, computed tomography, or elevated BNP/NT-proBNP levels and increased troponin are associated with short-term death in patients with acute PE at low risk based on clinical models. RVD assessment, mainly by BNP/NT-proBNP or echocardiography, should be considered to improve identification of low-risk patients that may be candidates for outpatient management or short hospital stay. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Patients with acute pulmonary embolism (PE) at low risk for short-term death are candidates for home treatment or short-hospital stay. We aimed at determining whether the assessment of right ventricle dysfunction (RVD) or elevated troponin improves identification of low-risk patients over clinical models alone. METHODS AND RESULTS: Individual patient data meta-analysis of studies assessing the relationship between RVD or elevated troponin and short-term mortality in patients with acute PE at low risk for death based on clinical models (Pulmonary Embolism Severity Index, simplified Pulmonary Embolism Severity Index or Hestia). The primary study outcome was short-term death defined as death occurring in hospital or within 30 days. Individual data of 5010 low-risk patients from 18 studies were pooled. Short-term mortality was 0.7% [95% confidence interval (CI) 0.4-1.3]. RVD at echocardiography, computed tomography or B-type natriuretic peptide (BNP)/N-terminal pro BNP (NT-proBNP) was associated with increased risk for short-term death (1.5 vs. 0.3%; OR 4.81, 95% CI 1.98-11.68), death within 3 months (1.6 vs. 0.4%; OR 4.03, 95% CI 2.01-8.08), and PE-related death (1.1 vs. 0.04%; OR 22.9, 95% CI 2.89-181). Elevated troponin was associated with short-term death (OR 2.78, 95% CI 1.06-7.26) and death within 3 months (OR 3.68, 95% CI 1.75-7.74). CONCLUSION: RVD assessed by echocardiography, computed tomography, or elevated BNP/NT-proBNP levels and increased troponin are associated with short-term death in patients with acute PE at low risk based on clinical models. RVD assessment, mainly by BNP/NT-proBNP or echocardiography, should be considered to improve identification of low-risk patients that may be candidates for outpatient management or short hospital stay. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Cecilia Becattini; Giancarlo Agnelli; Aldo Pietro Maggioni; Francesco Dentali; Andrea Fabbri; Iolanda Enea; Fulvio Pomero; Maria Pia Ruggieri; Andrea Di Lenarda; Michele Gulizia Journal: Intern Emerg Med Date: 2022-01-04 Impact factor: 5.472
Authors: Christopher Kabrhel; David R Vinson; Alice Marina Mitchell; Rachel P Rosovsky; Anna Marie Chang; Jackeline Hernandez-Nino; Stephen J Wolf Journal: J Am Coll Emerg Physicians Open Date: 2021-12-15