Thromb Haemost 2021; 121(12): 1660-1667
DOI: 10.1055/a-1475-2263
Stroke, Systemic or Venous Thromboembolism

Validation of the 2019 European Society of Cardiology Risk Stratification Algorithm for Pulmonary Embolism in Normotensive Elderly Patients

1  Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
,
Christine Baumgartner
1  Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
,
Marie Méan
2  Division of General Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
,
Odile Stalder
3  CTU Bern, University of Bern, Bern, Switzerland
,
Andreas Limacher
3  CTU Bern, University of Bern, Bern, Switzerland
,
Nicolas Rodondi
1  Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
4  Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
,
Drahomir Aujesky
1  Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
› Author Affiliations
Funding This work was supported by a grant from the Swiss National Science Foundation (grant numbers 33CSCO-122659, 139470). The sponsor had no role in the design and conduct of the study, in the collection, analysis, interpretation of the data, in the writing process, or in the decision to submit the article for publication.

Abstract

Background The 2019 European Society of Cardiology (ESC) guidelines recommend evaluation for right ventricular dysfunction in all normotensive patients with acute pulmonary embolism (PE). We compared the predictive performance of the 2019 and 2014 ESC risk stratification algorithms and the Pulmonary Embolism Severity Index (PESI).

Methods We performed a posthoc analysis of normotensive patients aged ≥ 65 years with acute PE from a prospective cohort. The primary outcome was overall mortality; secondary outcomes were PE-related mortality and adverse outcomes (PE-related death, cardiopulmonary resuscitation, intubation, catecholamine use, recurrent venous thromboembolism) at 30 days. We assessed outcomes in intermediate-high, intermediate-low, and low-risk groups according to the 2019 and 2014 ESC algorithms and the PESI. Discriminative power was compared using the area under the receiver operating characteristic curve (AUC).

Results Among 419 patients, 14 (3.3%) died (7 from PE) and 16 (3.8%) had adverse outcomes within 30 days. The 2019 ESC algorithm classified more patients as intermediate-high risk (45%) than the 2014 ESC algorithm (24%) or the PESI (37%), and only 19% as low risk (32% with 2014 ESC or the PESI). Discriminatory power for overall mortality was lower with the 2019 ESC algorithm (AUC: 63.6%), compared with the 2014 ESC algorithm (AUC: 71.5%) or the PESI (AUC: 75.2%), although the difference did not reach statistical significance (p = 0.063). Discrimination for PE-related mortality and adverse outcomes was similar.

Conclusion While categorizing more patients in higher risk groups, the 2019 ESC algorithm for PE did not improve prediction of short-term outcomes compared with the 2014 ESC algorithm or the PESI.

Author Contributions

All authors participated in the research and preparation of the manuscript. Study concept and design: D. Aujesky. Data acquisition: D. Aujesky, Marie Méan. Data analysis and interpretation: J. Moor, C. Baumgartner, Marie Méan, N. Rodondi, D. Aujesky. Drafting of the manuscript: J. Moor, C. Baumgartner, D. Aujesky. Critical revision of the manuscript: J. Moor, O. Stalder, A. Limacher, Marie Méan, C. Baumgartner, N. Rodondi, D. Aujesky. Statistical analyses: O. Stalder, A. Limacher. Study supervision: D. Aujesky, C. Baumgartner. Approval of the final manuscript: all authors.


Supplementary Material



Publication History

Received: 08 January 2021

Accepted: 01 April 2021

Publication Date:
06 April 2021 (online)

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