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著者: Mareike Lankeit, Vicente Gómez, Carolin Wagner, Drahomir Aujesky, Mónica Recio, Sem Briongos, Lisa K Moores, Roger D Yusen, Stavros Konstantinides, David Jiménez, Instituto Ramón y Cajal de Investigación Sanitaria Pulmonary Embolism Study Group
雑誌名: Chest. 2012 Apr;141(4):916-22. doi: 10.1378/chest.11-1355. Epub 2011 Aug 18.
Abstract/Text
BACKGROUND: This study aimed to assess the performance of two prognostic models-the European Society of Cardiology (ESC) model and the simplified Pulmonary Embolism Severity Index (sPESI)-in predicting short-term mortality in patients with pulmonary embolism (PE).
METHODS: We compared the test characteristics of the ESC model and the sPESI for predicting 30-day outcomes in a cohort of 526 patients with objectively confirmed PE. The primary end point of the study was all-cause mortality. The secondary end point included all-cause mortality, nonfatal symptomatic recurrent VTE, or nonfatal major bleeding.
RESULTS: Overall, 40 of 526 patients died (7.6%; 95% CI, 5.3%-9.9%) during the first month of follow-up. The sPESI classified fewer patients as low risk (31% [165 of 526], 95% CI, 27%-35%) compared with the ESC model (39% [207 of 526], 95% CI, 35% to 44%; P < .01). Importantly however, low-risk patients based on the sPESI had no 30-day mortality compared with 3.4% (95% CI, 0.9-5.8) in low-risk patients by the ESC model. The secondary end point occurred in 1.8% of patients in the sPESI low-risk and 5.8% in the ESC low-risk group (difference, 4.0 percentage points; 95% CI, 0.2-7.8). The prognostic ability of the ESC model remained significant in the subgroup of patients at high-risk according to the sPESI model (OR 1.95, 95% CI, 1.41 to 2.71, P < .001).
CONCLUSIONS: Both the sPESI and the ESC model successfully predict 30-day mortality after acute symptomatic PE, but exclusion of an adverse early outcome does not appear to require routine imaging procedures or laboratory biomarker testing.
PMID 21852296 Chest. 2012 Apr;141(4):916-22. doi: 10.1378/chest.11-1355. Epub 2011 Aug 18.
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