title: Acute pulmonary embolism: mortality prediction by the 2014 European Society of Cardiology risk stratification model.
abstract: The European Society of Cardiology (ESC) has proposed an updated risk stratification model for death in patients with acute pulmonary embolism based on clinical scores (Pulmonary Embolism Severity Index (PESI) or simplified PESI (sPESI)), right ventricle dysfunction (RVD) and elevated serum troponin (2014 ESC model).We assessed the ability of the 2014 ESC model to predict 30-day death after acute pulmonary embolism. Consecutive patients with symptomatic, confirmed pulmonary embolism included in prospective cohorts were merged in a collaborative database. Patients' risk was classified as high (shock or hypotension), intermediate-high (RVD and elevated troponin), intermediate-low (RVD or increased troponin or none) and low (sPESI 0). Study outcomes were death and pulmonary embolism-related death at 30 days.Among 906 patients (mean±sd age 68±16, 489 females), death and pulmonary embolism-related death occurred in 7.2% and 4.1%, respectively. Death rate was 22% in "high-risk" (95% CI 14.0-29.8), 7.7% in "intermediate-high-risk" (95% CI 4.5-10.9) and 6.0% in "intermediate-low-risk" patients (95% CI 3.4-8.6). One of the 196 "low-risk" patients died (0.5%, 95% CI 0-1.0; negative predictive value 99.5%).By using the 2014 ESC model, RVD or troponin tests would be avoided in about 20% of patients (sPESI 0), preserving a high negative predictive value. Risk stratification in patients at intermediate risk requires further improvement.
authors.affiliation: Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy cecilia.becattini@unipg.it.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Becattini
authors.affiliation: Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Agnelli
authors.affiliation: Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany.
authors.forename: Mareike
authors.initials: M
authors.lastname: Lankeit
authors.affiliation: Internal Medicine, Santa Maria Nuova Hospital, Florence, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Masotti
authors.affiliation: Dept of Internal Medicine and Cardiology, Warsaw Medical University, Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Pruszczyk
authors.affiliation: Ospedale San Carlo Borromeo, Milano, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Casazza
authors.affiliation: Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Vanni
authors.affiliation: Azienda Ospedaliera-Universitaria, Ancona, Italy.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Nitti
authors.affiliation: Dept of Vascular Medicine, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Pieter
authors.initials: P
authors.lastname: Kamphuisen
authors.affiliation: Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Vedovati
authors.affiliation: Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: De Natale
authors.affiliation: Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany.
authors.forename: Stavros
authors.initials: S
authors.lastname: Konstantinides
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002309:Cardiology / Q000592:standards*; D015331:Cohort Studies; D004452:Echocardiography; D005060:Europe; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007022:Hypotension; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D012306:Risk; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014336:Troponin / Q000097:blood; D018497:Ventricular Dysfunction, Right; D055815:Young Adult
chemical_list: D014336:Troponin