Highlights
- •Different scores have been developed for identifying intermediate-high risk patients with acute PE.
- •The Bova score showed the greatest ability to predict a complicated course among stable patients with acute pulmonary embolism.
- •Clinicians might consider the use of the Bova score to discuss advanced therapies with patients.
Abstract
Background
Various risk assessment tools have been proposed to identify stable patients with
acute pulmonary embolism (PE) who are at high risk of early adverse outcome (i.e.,
intermediate-high risk).
Methods
We evaluated the ability of the 2019 ESC, Bova, modified FAST and PEITHO-3 models
for predicting a 30-day complicated course (death, haemodynamic collapse, and/or recurrent
PE) in a cohort of 848 stable patients with acute PE. We also tested whether replacement
of echocardiographic right ventricle (RV) dysfunction by computed tomographic (CT)
RV enlargement provides comparable prognostic information for identifying these patients.
Results
A complicated course occurred in 63 (7.4 %) of the 848 patients with PE during the
first month of follow-up. The proportion of patients designated as having intermediate-high
risk PE was 6.7 % with the ESC model, 4.4 % with the Bova score, 15.7 % with the FAST
score, and 5.2 % with the PEITHO-3 model. However, among patients identified as intermediate-high
risk, the 30-day complicated course rate was higher with the Bova score (21.6 %) than
with the ESC model (17.5 %), the PEITHO-3 model (15.9 %), or the modified FAST score
(14.3 %). When echocardiographic RV dysfunction was replaced by CT RV enlargement
in the models, the proportion of patients classified as having intermediate-high risk
PE and the rate of an adverse outcome among them slightly increased.
Conclusions
The Bova score might identify patients with intermediate-high risk PE slightly better
than the ESC, PEITHO-3, and modified FAST score. When echocardiography is not readily
available, CT-assessed RV enlargement might be used for identifying intermediate-high
risk PE.
ClinicalTrials.gov number: NCT02238639.
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Article info
Publication history
Published online: January 23, 2023
Accepted:
January 18,
2023
Received in revised form:
November 11,
2022
Received:
July 12,
2022
Identification
Copyright
© 2023 Elsevier Ltd. All rights reserved.
