Pulmonary embolism risk stratification by European Society of Cardiology is associated with recurrent venous thromboembolism: Findings from a long-term follow-up study

Zhang, Shuai; Zhai, Zhenguo; Yang, Yuanhua; Zhu, Jianguo; Kuang, Tuguang; Xie, Wanmu; Yang, Suqiao; Liu, Fangfang; Gong, Juanni; Shen, Ying H.; Wang, Chen

doi:10.1016/j.ijcard.2014.09.142

Cited by 11 publications

(8 citation statements)

References 48 publications

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“…In contrast to two previous studies [ 33 , 34 ], our study is the first to show an association between the CTOI and VTE recurrence. Den Exter et al focused on the association between thromboembolic resolution assessed by CTPA and VTE recurrence, mentioning that the CTOI was not associated with recurrent VTE (no data shown) [ 33 ].…”

Section: Discussioncontrasting

confidence: 89%

Association between computed tomography obstruction index and mortality in elderly patients with acute pulmonary embolism: A prospective validation study

et al. 2017

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IntroductionComputed tomography pulmonary angiography (CTPA) has not only become the method of choice for diagnosing acute pulmonary embolism (PE), it also allows for risk stratification of patients with PE. To date, no study has specifically examined the predictive value of CTPA findings to assess short-term prognosis in elderly patients with acute PE who are particularly vulnerable to adverse outcomes.MethodsWe studied 291 patients aged ≥65 years with acute symptomatic PE in a prospective multicenter cohort. Outcomes were 90-day overall and PE-related mortality, recurrent venous thromboembolism (VTE), and length of hospital stay (LOS). We examined associations of the computed tomography obstruction index (CTOI) and the right ventricular (RV) to left ventricular (LV) diameter ratio with mortality and VTE recurrence using survival analysis, adjusting for provoked VTE, Pulmonary Embolism Severity Index (PESI), and anticoagulation as a time-varying covariate.ResultsOverall, 15 patients died within 90 days. There was no association between the CTOI and 90-day overall mortality (adjusted hazard ratio per 10% CTOI increase 0.92; 95% confidence interval [CI] 0.70–1.21; P = 0.54), but between the CTOI and PE-related 90-day mortality (adjusted sub-hazard ratio per 10% CTOI increase 1.36; 95% CI 1.03–1.81; P = 0.03). The RV/LV diameter ratio was neither associated with overall nor PE-related 90-day mortality. The CTOI and the RV/LV diameter ratio were significantly associated with VTE recurrence and LOS.ConclusionsIn elderly patients with acute PE, the CTOI was associated with PE-related 90-day mortality but not with overall 90-day mortality. The RV/LV diameter ratio did not predict mortality. Both measures predicted VTE recurrence and LOS. The evaluated CTPA findings do not appear to offer any advantage over the PESI in terms of mortality prediction.

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Section: Discussioncontrasting

confidence: 89%

Association between computed tomography obstruction index and mortality in elderly patients with acute pulmonary embolism: A prospective validation study

et al. 2017

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“…There are different results as to whether the clot burden score is a definite factor for risk classification. Both Shen et al ( 22 ) and Zhang et al ( 23 ) showed that the clot burden score was significantly related to the high-risk group and was a determinant for this risk group in their studies. In our study, the mean clot burden score belonging to the high-risk group was lower, though its results broadly correlated to results of previous studies in the literature.…”

Section: Discussionmentioning

confidence: 94%

Correlation of Trombosed Vessel Location and Clot Burden Score with Severity of Disease and Risk Stratification in Patients with Acute Pulmonary Embolism

et al. 2020

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Objective: Computed tomography pulmonary angiography (CTPA) is used for the main diagnosis in acute pulmonary embolism (APE). Determining the thrombus location in the pulmonary vascular tree is also important for predicting disease severity. This study aimed to analyze the correlation of the thrombus location and the clot burden with the disease severity and the risk stratification in patients with APE. Methods: The study included patients with APE diagnosed by CTPA who were admitted to the hospital between January 28, 2016, and July 1, 2019. Data collected were markers of severity in APE, including patient demographics, comorbidities, length of hospital stay, pulmonary embolism severity index (PESI) score, modified PESI score, Wells score, risk stratification according to the American Heart Association, systolic blood pressure (SBP), right ventricle diameter to left ventricle diameter ratio, pulmonary arterial pressure, brain natriuretic peptide, troponin, D-dimer, and plasma lactate levels, and vessel location of the thrombus, clot burden score, ratio of the pulmonary artery trunk diameter/aortic diameter, superior vena cava diameter (SVC) by CTPA, and survival. All parameters were analyzed in correlation with clot load and vessel location. Results: Thrombus vascular location was found to be correlated with risk stratification and negatively correlated with SBP. Simplified Mastora score was correlated with risk stratification, SVC diameter, and D-dimer and negatively correlated with SBP. Occlusion of both the pulmonary artery trunk and any pulmonary artery with thrombus was associated with massive APE. Conclusion: The level of the occluded vessel on CTPA may provide the ability to risk-stratify, and the clot burden score may be used for assessing both risk stratification and cardiac strain.

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“…The simplified PESI After a diagnosis is made, high prognostic risk patients are identifiable by signs of shock and respiratory failure, but intermediate and low-risk patients are difficult to differentiate. 44 The three most sensitive CPS are the PESI, sPESI and ESC guideline risk stratification criteria, with sensitivities of 0.89, 0.92 and 0.88, respectively, with the sPESI (Table 1) as the most validated. 5,45,46 A sPESI score = 0 ('low risk') has a reported 30-day mortality rate of 1.0-1.5%, while a score ≥1 ('high risk') is 10.7-10.9%, but can be over 20% in haemodynamically unstable patients.…”

Section: Intermediate and High-risk Patientsmentioning

confidence: 99%

“…A sPESI ≥1 indicates a need for admission, while a sPESI = 0 should prompt consideration of early discharge and outpatient management. 44,[52][53][54][55][56] The sPESI is a useful tool in decision-making, but it should not be the only factor considered when making early management choices.…”

Section: Intermediate and High-risk Patientsmentioning

confidence: 99%

Acute pulmonary embolism: a concise review of diagnosis and management

Hepburn-Brown

Darvall

Hammerschlag

2019

Internal Medicine Journal

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An acute pulmonary embolism (aPE) is characterised by occlusion of one or more pulmonary arteries. Physiological disturbance may be minimal, but often cardiac output decreases as the right ventricle attempts to overcome increased afterload. Additionally, ventilation‐perfusion mismatches can develop in affected vascular beds, reducing systemic oxygenation. Incidence is reported at 50–75 per 100 000 in Australia and New Zealand, with 30‐day mortality rates ranging from 0.5% to over 20%. Incidence is likely to increase with the ageing population, increased survival of patients with comorbidities that are considered risk factors and improving sensitivity of imaging techniques. Use of clinical prediction scores, such as the Wells score, has assisted in clinical decision‐making and decreased unnecessary radiological investigations. However, imaging (i.e. computed tomography pulmonary angiography or ventilation‐perfusion scans) is still necessary for objective diagnosis. Anti‐coagulation remains the foundation of PE management. Haemodynamically unstable patients require thrombolysis unless absolutely contraindicated, while stable patients with right ventricular dysfunction or ischaemia should be aggressively anti‐coagulated. Stable patients with no right ventricular dysfunction can be discharged home early with anti‐coagulation and review. However, treatment should be case dependent with full consideration of the patient’s clinical state. Direct oral anti‐coagulants have become an alternative to vitamin K antagonists and are facilitating shorter hospital admissions. Additionally, duration of anti‐coagulation must be decided by considering any provoking factors, bleeding risk and comorbid state. Patients with truly unprovoked or idiopathic PE often require indefinite treatment, while in provoked cases it is typically 3 months with some patients requiring longer periods of 6–12 months.

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Pulmonary embolism risk stratification by European Society of Cardiology is associated with recurrent venous thromboembolism: Findings from a long-term follow-up study

Cited by 11 publications

References 48 publications

Association between computed tomography obstruction index and mortality in elderly patients with acute pulmonary embolism: A prospective validation study

Association between computed tomography obstruction index and mortality in elderly patients with acute pulmonary embolism: A prospective validation study

Correlation of Trombosed Vessel Location and Clot Burden Score with Severity of Disease and Risk Stratification in Patients with Acute Pulmonary Embolism

Acute pulmonary embolism: a concise review of diagnosis and management

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