title: A strategy combining imaging and laboratory biomarkers in comparison with a simplified clinical score for risk stratification of patients with acute pulmonary embolism.
abstract: 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.
authors.affiliation: Department of Cardiology and Pulmonology, University of Göttingen, Göttingen, Germany.
authors.forename: Mareike
authors.initials: M
authors.lastname: Lankeit
authors.affiliation: Medicine Department, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Gómez
authors.affiliation: Respiratory Department, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain.
authors.forename: Carolin
authors.initials: C
authors.lastname: Wagner
authors.affiliation: Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland.
authors.forename: Drahomir
authors.initials: D
authors.lastname: Aujesky
authors.affiliation: Cardiology Department, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain.
authors.forename: Mónica
authors.initials: M
authors.lastname: Recio
authors.affiliation: Cardiology Department, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain.
authors.forename: Sem
authors.initials: S
authors.lastname: Briongos
authors.affiliation: F. Edward Hebert School of Medicine, Uniformed Services University, Bethesda, MD.
authors.forename: Col Lisa K
authors.initials: CLK
authors.lastname: Moores
authors.affiliation: Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences, Washington University School of Medicine, St. Louis, MO.
authors.forename: Roger D
authors.initials: RD
authors.lastname: Yusen
authors.affiliation: Department of Cardiology and Pulmonology, University of Göttingen, Göttingen, Germany; Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Stavros
authors.initials: S
authors.lastname: Konstantinides
authors.affiliation: Respiratory Department, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain. Electronic address: djc_69_98@yahoo.com.
authors.forename: David
authors.initials: D
authors.lastname: Jiménez
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D011379:Prognosis; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D012720:Severity of Illness Index; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I