ACUTE PULMONARY EMBOLISM: EXTERNAL VALIDATION OF AN INTEGRATED RISK STRATIFICATION MODEL.

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ACUTE PULMONARY EMBOLISM: EXTERNAL VALIDATION OF AN INTEGRATED RISK STRATIFICATION MODEL.

Chest. 2013 Jun 13;

Authors: Becattini C, Casazza F, Forgione C, Porro F, Fadin BM, Stucchi A, Lignani A, Conte L, Imperadore F, Bongarzoni A, Agnelli G

Abstract
ABSTRACT BACKGROUND In hemodynamically stable patients with acute pulmonary embolism risk stratification is essential to drive clinical management. In these patients, risk stratification for in-hospital adverse outcome based on markers of right ventricle dysfunction and injury has been proposed. METHODS The aim of this study was to validate a model based on the incremental prognostic value of right ventricle dysfunction and injury in hemodynamically stable patients with acute pulmonary embolism. Patients from the prospective Italian Pulmonary Embolism Registry (IPER) were included in the study. Study outcomes were in-hospital death and the composite of in-hospital death or clinical deterioration. RESULTS Among 1515 hemodynamically stable patients, 869 had both echocardiography and troponin assessments. The risk for in-hospital death or clinical deterioration was higher in patients with right ventricle dysfunction and elevated troponin (8.8%; HR 14.2; 95% CI 1.94-104.16; p< 0.01) and with either right ventricle dysfunction or elevated troponin (4.7%; HR 7.9; 95% CI 1.1-59.9; p< 0.05) compared to patients without dysfunction and normal troponin. The negative predictive value of the model was 100% for in-hospital death and 99% for death or clinical deterioration. c-statistics showed an improvement of the discriminatory power for in-hospital death or clinical deterioration by using the overall model (0.66; 95% CI 0.60-0.73) over either echocardiography (0.59, 95% CI 0.53-0.67) or troponin (0.61, 95% CI 0.53-0.69) alone. CONCLUSIONS A model including both right ventricle dysfunction and injury has an incremental prognostic value for risk stratification in hemodynamically stable patients with acute pulmonary embolism. Patients with no dysfunction or injury have a favourable outcome. (Clinicaltrials.gov NCT01604538).

PMID: 23764909 [PubMed - as supplied by publisher]

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