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Comparison of various prognostic scores for identification of patients with intermediate-high risk pulmonary embolism

  • Rosa Mirambeaux
    Affiliations
    Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain
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  • Carmen Rodríguez
    Affiliations
    Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain
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  • Alfonso Muriel
    Affiliations
    Biostatistics Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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  • Sara González
    Affiliations
    Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain
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  • Winnifer Briceño
    Affiliations
    Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain
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  • Diego Durán
    Affiliations
    Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain
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  • Ana Retegui
    Affiliations
    Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain
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  • Remedios Otero
    Affiliations
    Respiratory Department, Virgen del Rocío Hospital and Instituto de Biomedicina, Sevilla, Spain

    CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
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  • Behnood Bikdeli
    Affiliations
    Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA

    Center for Outcomes Research and Evaluation (CORE), Yale University School of Medicine, New Haven, CT, USA

    Cardiovascular Research Foundation, New York, USA
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  • David Jiménez
    Correspondence
    Corresponding author at: Respiratory Department and Medicine Department, Ramón y Cajal Hospital, IRYCIS and Alcalá University, CIBER Enfermedades Respiratorias (CIBERES), Colmenar Road, Km. 9, 100, 28034 Madrid, Spain.
    Affiliations
    Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain

    CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain

    Medicine Department, Universidad de Alcalá, Madrid, Spain
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      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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