Identification of intermediate-risk patients with acute symptomatic pulmonary embolism

Abstract

The identification of normotensive patients with acute pulmonary embolism (PE) at high risk of adverse PE-related clinical events (i.e. intermediate-risk group) is a major challenge.We combined individual patient data from six studies involving 2874 normotensive patients with PE. We developed a prognostic model for intermediate-risk PE based on the clinical presentation and the assessment of right ventricular dysfunction and myocardial injury. We used a composite of PE-related death, haemodynamic collapse or recurrent PE within 30 days of follow-up as the main outcome measure.The primary outcome occurred in 198 (6.9%) patients. Predictors of complications included systolic blood pressure 90-100 mmHg (adjusted odds ratio (aOR) 2.45, 95% CI 1.50-3.99), heart rate o110 beats per min (aOR 1.87, 95% CI 1.31-2.69), elevated cardiac troponin (aOR 2.49, 95% CI 1.71-3.69) and right ventricular dysfunction (aOR 2.28, 95% CI 1.58-3.29). We used these variables to construct a multidimensional seven-point risk index; the odds ratio for complications per one-point increase in the score was 1.55 (95% CI 1.43-1.68; p,0.001). The model identified three stages (I, II and III) with 30-day PE-related complication rates of 4.2%, 10.8% and 29.2%, respectively.In conclusion, a simple grading system may assist clinicians in identifying intermediate-risk PE. @ERSpublications A simple grading system to identify intermediate-risk pulmonary embolism

Risk Stratification of Patients With Acute Symptomatic Pulmonary Embolism Based on Presence or Absence of Lower Extremity DVT

“…For example, patients at low risk for early complications (i.e., death, recurrent venous thromboembolism [VTE], and major bleeding) might be considered for partial or complete outpatient PE treatment (3). Alternatively, normotensive patients at high risk of early death may benefit from more intensive surveillance or aggressive therapy (i.e., intermediate-risk group) (4,5).…”

Pulmonary embolism in old age: usefulness of risk stratification in clinical decision-making

“…According to this latter, the patient had a risk of about 29-37% for short-term adverse events PE-related. 18,19 Anticoagulation was started with enoxaparin 1 mg/kg subcutaneously. One hour later, the arterial pressure fell to 60/40 mm Hg, and signs of peripheral hypo-perfusion manifested.…”

“…17 Among them, the most extensively validated is the Bova score (Table 2). 18,19 Recently, an algorithm for the risk-stratification of patients with PE has been proposed by the European Society of Cardiology (ESC) ( Table 3). 17 …”

Pulmonary embolism: clinical guidelines of European Society of Cardiology (2014).The Task Force of the European Society of Cardiology for diagnosis and management of pulmonary embolism

“…Вследствие этого для улучшения стратификации больных в регистровых и когортных исследованиях изучались различные сочетания клинических дан ных, визуализационных и лабораторных показа телей [222,246,[254][255][256][257][258][259]. Требуется дальнейшее изучение клинического значения большинства этих методов прогноза и шкал, особенно применительно к лечебной тактике.…”