Haemodynamically unstable pulmonary embolism in the RIETE Registry: systolic blood pressure or shock index?

Abstract

Patients with acute pulmonary embolism (PE) presenting with haemodynamic instability have the worst prognosis. However, what is understood by haemodynamic instability has not been clearly defined.The Registro Informatizado de la Enfermedad Tromboembólica (RIETE) is an ongoing registry of consecutive patients with symptomatic, objectively confirmed, acute deep vein thrombosis or PE. The present authors compared the predictive value of a systolic blood pressure (SBP) value of ,100 mmHg and ,90 mmHg and the shock index (cardiac frequency divided by SBP) on 30-day mortality in consecutive patients with PE.As of May 2006, 6,599 patients with PE were enrolled in the study. Of these, 417 (6.3%) died within 30 days: 153 of the initial PE, 29 of recurrent PE and 235 due to other causes. Of the 417 individuals who died, 127 (30%) had a positive shock index, 60 (14%) had SBP ,100 mmHg and 33 (7.9%) had SBP ,90 mmHg. On multivariate analysis any of the three parameters were independently associated with an increased mortality. The shock index had a higher sensitivity (30.5 versus 14.4 and 7.9% for SBP ,100 mmHg and ,90 mmHg, respectively) but lower specificity (86.3 versus 93.0 and 96.6).All three measures of haemodynamic instability are independent predictors of 30-day mortality. However, while the shock index had the highest sensitivity, a systolic blood pressure value ,90 mmHg had the highest specificity.

Shock Index More Sensitive Than Cardiogenic Shock in ST-Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

“…3- 7 The combination of HR and SBP may be more powerful than either HR or SBP alone, because early stages of shock are also taken into account. Therefore, SI can be a good marker of pre-shock.…”

The Advanced Tactics of the Management of Patients With Venous Thromboembolism: The Role of Rivaroxaban at Various Stages of Treatment

“…По данным обсер-вационных исследований число таких больных, у раз-ных авторов, составляет от 4,2 до 18,5% [11][12][13][14]. Причем попытки расширить показания к примене-нию ТЛТ у больных с ТЭЛА оказались безуспешными.…”

Prognostic role of the simplified pulmonary embolism severity index and shock index in pulmonary embolism

“…14 The shock index (SI), defined as the heart rate divided by systolic blood pressure, is an independent prognostic model of 30-day mortality in patients with PE. 15 A multicenter study demonstrated that the SI had high sensitivity in identifying the subgroups of patients at low risk of mortality. 15 In a new approach, this index is used to speed up the triage of patients with suspected acute PE.…”

“…15 A multicenter study demonstrated that the SI had high sensitivity in identifying the subgroups of patients at low risk of mortality. 15 In a new approach, this index is used to speed up the triage of patients with suspected acute PE. 16 If the SI is 1 and higher and right ventricular dysfunction (RVD) is present on an echocardiogram in PE patients in poor general condition, early thrombolytic treatment can be administered without imaging studies.…”

“…Patients with an SI of 1 or higher were defined as high-risk, while those with an SI of less than 1 were considered low-risk. 15 We also assessed the ability of the prediction rules to identify low-risk patients with acute PE who could be candidates for treatment in the outpatient setting. All patients gave informed consent to participate in the prospective registry in accordance with the requirements of the local ethics committee.…”