title: Comparison of risk assessment strategies for not-high-risk pulmonary embolism.
abstract: We compared the prognostic performance of the 2014 European Society of Cardiology (ESC) risk stratification algorithm with the previous 2008 ESC algorithm, the Bova score and the modified FAST score (based on a positive heart-type fatty acid-binding protein (H-FABP) test, syncope and tachycardia, modified using high-sensitivity troponin T instead of H-FABP) in 388 normotensive pulmonary embolism patients included in a single-centre cohort study.Overall, 25 patients (6.4%) had an adverse 30-day outcome. Regardless of the score or algorithm used, the rate of an adverse outcome was highest in the intermediate-high-risk classes, while all patients classified as low-risk had a favourable outcome (no pulmonary embolism-related deaths, 0-1.4% adverse outcome). The area under the curve for predicting an adverse outcome was higher for the 2014 ESC algorithm (0.76, 95% CI 0.68-0.84) compared with the 2008 ESC algorithm (0.65, 95% CI 0.56-0.73) and highest for the modified FAST score (0.82, 95% CI 0.75-0.89). Patients classified as intermediate-high-risk by the 2014 ESC algorithm had a 8.9-fold increased risk for an adverse outcome (3.2-24.2, p<0.001 compared with intermediate-low- and low-risk patients), while the highest OR was observed for a modified FAST score ≥3 points (OR 15.9, 95% CI 5.3-47.6, p<0.001).The 2014 ESC algorithm improves risk stratification of not-high-risk pulmonary embolism compared with the 2008 ESC algorithm. All scores and algorithms accurately identified low-risk patients, while the modified FAST score appears more suitable to identify intermediate-high-risk patients.
authors.affiliation: Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany Center for Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
authors.forename: Lukas
authors.initials: L
authors.lastname: Hobohm
authors.affiliation: Clinic of Cardiology and Pneumology, Heart Center, University of Göttingen, Göttingen, Germany.
authors.forename: Kristian
authors.initials: K
authors.lastname: Hellenkamp
authors.affiliation: Clinic of Cardiology and Pneumology, Heart Center, University of Göttingen, Göttingen, Germany German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Hasenfuß
authors.affiliation: Center for Cardiology, Cardiology I, University Medical Center of the Johannes Gutenberg University, Mainz, Germany German Center for Cardiovascular Research, Partner Site Rhein-Main, Mainz, Germany Center for Translational Vascular Biology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Münzel
authors.affiliation: Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
authors.forename: Stavros
authors.initials: S
authors.lastname: Konstantinides
authors.affiliation: Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany Clinic of Cardiology and Pneumology, Heart Center, University of Göttingen, Göttingen, Germany mlankeit@uni-mainz.de.
authors.forename: Mareike
authors.initials: M
authors.lastname: Lankeit
mesh_terms: D000368:Aged; D000465:Algorithms; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000628:therapy*; D012372:ROC Curve; D012044:Regression Analysis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013575:Syncope; D013610:Tachycardia / Q000097:blood
chemical_list: C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins