Comparison of two Prognostic Models for Acute Pulmonary Embolism: clinical vs right Ventricular Dysfunction Guided Approach.
J Thromb Haemost. 2011 Aug 5;
Authors: Vanni S, Nazerian P, Pepe G, Baioni M, Michele R, Grifoni G, Viviani G, Grifoni S
Background: Recently, some prognostic models for acute Pulmonary Embolism (PE) have been proposed. We investigated whether the Pulmonary Embolism Severity Index (PESI) and the European Society of Cardiology (ESC) prognostic approach result in different prognostications. Methods: Consecutive adult patients with acute PE were included. According to the ESC guidelines, high-risk patients were identified by the presence of shock/hypotension, intermediate-risk patients by elevated Troponin I or RVD assessed by echocardiography, and low-risk patients by the absence of any of the above. In the PESI, eleven clinical variables, easily accessible at bedside, were used to generate three risk classes. Main outcomes were all-cause and PE-related in-hospital mortality. Results: Forty-one patients (8%,CI95% 5.8-10.8) out of 510 died. According to the ESC, 40% were at low, 54% at intermediate and 6% at high risk of short-term mortality. The distribution according to PESI was 31% (P<0.05 vs ESC), 49% and 20% (P<0.05 vs ESC) respectively. Mortality increased through the risk classes (P<0.01) without significant differences between the models. The ESC model identified with higher accuracy than the PESI both high-risk and low-risk patients (P<0.05 for both). When patients with shock/hypotension were excluded, the PESI stratified patients into classes with increasing PE-related mortality (0.7%,4.3%,11.6%, P<0.05). Troponin I and RVD added incremental prognostic value to the PESI, particularly in normotensive patients at intermediate-risk. Conclusions: The ESC model showed higher accuracy than the PESI in identifying high and low-risk patients. In normotensive patients, the PESI could guide clinical management as well as troponin I and echocardiography testing.
PMID: 21819540 [PubMed - as supplied by publisher]