Identification of Low-risk Patients With Acute Symptomatic Pulmonary Embolism
Arch. bronconeumol. (Ed. impr.)
; 59(9)sep. 2023. mapas, graf, tab
Article
in English
| IBECS
| ID: ibc-224997
Responsible library:
ES1.1
Localization: ES15.1 - BNCS
ABSTRACT
Background:
Identification of patients with acute symptomatic pulmonary embolism (PE) who are at low-risk for short-term complications to warrant outpatient care lacks clarity.Method:
In order to identify patients at low-risk for 30-day all-cause and PE-related mortality, we used a cohort of haemodynamically stable patients from the RIETE registry to compare the false-negative rate of four strategies the simplified Pulmonary Embolism Severity Index (sPESI); a modified (i.e., heart rate cutoff of 100beats/min) sPESI; and a combination of the original and the modified sPESI with computed tomography (CT)-assessed right ventricle (RV)/left ventricle (LV) ratio.Results:
Overall, 137 of 3117 patients with acute PE (4.4%) died during the first month. Of these, 41 (1.3%) died from PE, and 96 (3.1%) died from other causes. The proportion of patients categorized as having low-risk was highest with the sPESI and lowest with the combination of a modified sPESI and CT-assessed RV/LV ratio (32.5% versus 16.5%; P<0.001). However, among patients identified as low-risk, the 30-day mortality rate was lowest with the combination of a modified sPESI and CT-assessed RV/LV ratio and highest with the sPESI (0.4% versus 1.0%; P=0.03). The 30-day PE-related mortality rates for patients designated as low-risk by the sPESI, the modified sPESI, and the combination of the original and modified sPESI with CT-assessed RV/LV ratio were 0.7%, 0.4%, 0.7%, and 0.2%, respectively.Conclusions:
The combination of a negative modified sPESI with CT-assessed RV/LV ratio ≤1 identifies patients with acute PE who are at very low-risk for short-term mortality. (AU)
Full text:
Available
Collection:
National databases
/
Spain
Database:
IBECS
Main subject:
Pulmonary Embolism
Limits:
Humans
Language:
English
Journal:
Arch. bronconeumol. (Ed. impr.)
Year:
2023
Document type:
Article
Institution/Affiliation country:
Harvard Medical School/USA
/
Hospital Olot i Comarcal de la Garrotxa/Spain
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Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS/Spain
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Hospital Universitari de Bellvitge/Spain
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Hospital Universitario de Gran Canaria Dr. Negrín/Spain
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Hospital de Galdakao/Spain
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Municipal Hospital of Dresden Friedrichstadt/Germany
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Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS/Spain
/
Riga Stradiņ University/Latvia