Identification of Low-risk Patients With Acute Symptomatic Pulmonary Embolism

• David Jiménez ^[4] ; Behnood Bikdeli ^[1] ; Carmen Rodríguez ^[4] ; Alfonso Muriel ^[5] ; Aitor Ballaz ^[2] ; Silvia Soler ^[6] ; Sebastian Schellong ^[7] ; Aída Gil-Díaz ^[8] ; Andris Skride ^[9] ; Antoni Riera-Mestre ^[3] ; Manuel Monreal ^[10]
  1. [1] Harvard Medical School

     Harvard Medical School

     City of Boston, Estados Unidos

     
  2. [2] Hospital de Galdakao - Usansolo

     Hospital de Galdakao - Usansolo

     Galdakano, España

     
  3. [3] Hospital Universitari de Bellvitge

     Hospital Universitari de Bellvitge

     l'Hospitalet de Llobregat, España

     
  4. [4] Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain
  5. [5] Biostatistics Department, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, CIBERESP, Madrid, Spain
  6. [6] Department of Internal Medicine, Hospital Olot i Comarcal de la Garrotxa, Gerona, Spain
  7. [7] Department of Medical Clinic, Municipal Hospital of Dresden Friedrichstadt, Dresden, Germany
  8. [8] Department of Internal Medicine, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
  9. [9] Department of Cardiology, Ospedale Pauls Stradins Clinical University Hospital, Riga Stradiņš University, Riga, Latvia
  10. [10] Chair for the Study of Thromboembolic Disease, Faculty of Health Sciences, UCAM-Universidad Católica San Antonio de Murcia, Murcia, Spain

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• Localización: Archivos de bronconeumología: Organo oficial de la Sociedad Española de Neumología y Cirugía Torácica SEPAR y la Asociación Latinoamericana de Tórax ( ALAT ), ISSN 0300-2896, Vol. 59, Nº. 9, 2023, págs. 575-580
• Idioma: inglés
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• Dialnet Métricas: 1 Cita
• Resumen

  • Background Identification of patients with acute symptomatic pulmonary embolism (PE) who are at low-risk for short-term complications to warrant outpatient care lacks clarity.

    Method In order to identify patients at low-risk for 30-day all-cause and PE-related mortality, we used a cohort of haemodynamically stable patients from the RIETE registry to compare the false-negative rate of four strategies: the simplified Pulmonary Embolism Severity Index (sPESI); a modified (i.e., heart rate cutoff of 100 beats/min) sPESI; and a combination of the original and the modified sPESI with computed tomography (CT)-assessed right ventricle (RV)/left ventricle (LV) ratio.

    Results Overall, 137 of 3117 patients with acute PE (4.4%) died during the first month. Of these, 41 (1.3%) died from PE, and 96 (3.1%) died from other causes. The proportion of patients categorized as having low-risk was highest with the sPESI and lowest with the combination of a modified sPESI and CT-assessed RV/LV ratio (32.5% versus 16.5%; P < 0.001). However, among patients identified as low-risk, the 30-day mortality rate was lowest with the combination of a modified sPESI and CT-assessed RV/LV ratio and highest with the sPESI (0.4% versus 1.0%; P = 0.03). The 30-day PE-related mortality rates for patients designated as low-risk by the sPESI, the modified sPESI, and the combination of the original and modified sPESI with CT-assessed RV/LV ratio were 0.7%, 0.4%, 0.7%, and 0.2%, respectively.

    Conclusions The combination of a negative modified sPESI with CT-assessed RV/LV ratio ≤1 identifies patients with acute PE who are at very low-risk for short-term mortality.