Chest
Original ResearchPulmonary Vascular DiseaseA Strategy Combining Imaging and Laboratory Biomarkers in Comparison With a Simplified Clinical Score for Risk Stratification of Patients With Acute Pulmonary Embolism
Section snippets
Study Design
Using prospectively collected baseline data at the time of PE diagnosis and outcome data from the same cohort, we assessed the test characteristics of the simplified PESI and the ESC prognostic score for predicting 30-day mortality, nonfatal recurrent VTE, and nonfatal major bleeding. We then assessed the ability of both prediction rules to identify low-risk patients with acute PE who could be candidates for treatment in the outpatient setting. All patients provided informed consent for their
Results
We screened 628 consecutive patients with acute PE for eligibility. The study excluded 21 patients due to lack of troponin testing within 12 h after the diagnosis of PE. Other reasons for exclusion were a technically inadequate or unavailable transthoracic echocardiogram (n = 54), loss to follow-up (n = 15), and refusal to give informed consent (n = 19). Some patients had multiple reasons for exclusion. A total of 526 patients (227 men and 299 women; 85% of the screened population) were
Discussion
Our study validated the recently proposed ESC “instrumental” model (which focuses on biomarkers and imaging findings of RV dysfunction and failure) for risk-stratifying patients with acute symptomatic PE and compared it with the sPESI, a score based on baseline clinical findings and comorbidity. Both the sPESI and the ESC model successfully predicted 30-day mortality after acute symptomatic PE, but an adverse early outcome could safely be excluded using the sPESI alone, without requiring
Acknowledgments
Author contributions: Dr Lankeit: contributed to study concept and design, acquisition of data, analysis and interpretation of data, statistical analysis, critical revision of the manuscript for important intellectual content, and drafting of the manuscript.
Dr Gómez: contributed to study concept and design, acquisition of data, analysis and interpretation of data, statistical analysis, critical revision of the manuscript for important intellectual content, and drafting of the manuscript.
Dr
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Cited by (0)
Drs Lankeit and Gómez contributed equally to the manuscript.
Funding/Support: This work has been supported in part by Instituto de Salud Carlos III [FIS 08/0200], Sociedad Española de Neumología y Cirugía Torácica [SEPAR 2008], and NEUMOMADRID 2010.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).
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A complete list of participants is located in e-Appendix 1.