Identification of Low-risk Patients With Acute Symptomatic Pulmonary Embolism

被引:5
作者
Jimenez, David [1 ,2 ,3 ,4 ]
Bikdeli, Behnood [5 ,6 ,7 ,8 ]
Rodriguez, Carmen [1 ,2 ]
Muriel, Alfonso [9 ,10 ]
Ballaz, Aitor [11 ]
Soler, Silvia [12 ]
Schellong, Sebastian [13 ]
Gil-Diaz, Aida [14 ]
Skride, Andris [15 ]
Monreal, Manuel [17 ]
机构
[1] Hosp Ramon & Cajal, Resp Dept, Madrid, Spain
[2] Inst Ramon & Cajal Invest Sanitaria IRYCIS, Madrid, Spain
[3] Univ Alcala, Dept Med, Madrid, Spain
[4] CIBER Enfermedades Resp CIBERES, Madrid, Spain
[5] Harvard Med Sch, Brigham & Womens Hosp, Cardiovasc Med Div, Boston, MA USA
[6] Harvard Med Sch, Brigham & Womens Hosp, Thrombosis Res Grp, Boston, MA USA
[7] Yale Ctr Outcomes Res & Evaluat CORE, YNHH, New Haven, CT USA
[8] Cardiovasc Res Fdn CRF, New York, NY USA
[9] Ramon & Cajal Hosp, Biostat Dept, Madrid, Spain
[10] CIBERESP, Inst Ramon & Cajal Invest Sanitaria IRYCIS, Madrid, Spain
[11] Hosp Galdakao, Dept Pneumonol, Vizcaya, Spain
[12] Hosp Olot I Comarcal Garrotxa, Dept Internal Med, Garrotxa, Spain
[13] Municipal Hosp Dresden Friedrichstadt, Dept Med Clin, Dresden, Germany
[14] Hosp Univ Gran Canaria Dr Negrin, Dept Internal Med, Las Palmas Gran Canaria, Spain
[15] Riga Stradins Univ, Dept Cardiol, Osped Pauls Stradins Clin Univ Hosp, Riga, Latvia
[16] Hosp Univ Bellvitge, Bellvitge Biomed Res Inst IDIBELL, Internal Med Dept, Barcelona, Spain
[17] UCAM Univ Catolica San Antonio Murcia, Fac Hlth Sci, Chair Study Thromboembol Dis, Murcia, Spain
来源
ARCHIVOS DE BRONCONEUMOLOGIA | 2023年 / 59卷 / 09期
关键词
Pulmonary embolism; Prognosis; Clinical scores; Right ventricular dysfunction; Heart rate; VENOUS THROMBOEMBOLISM; SEVERITY INDEX; OUTPATIENT; VALIDATION; DIAGNOSIS; PROGNOSTICATION; DERIVATION; CRITERIA; REGISTRY; HESTIA;
D O I
10.1016/j.arbres.2023.06.010
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
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 ratecut off 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-daymortality 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 modifieds PESI 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. (c) 2023 SEPAR. Published by Elsevier Espana, S.L.U. All rights reserved.
引用
收藏
页码:575 / 580
页数:6
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