Validation of the 2019 European Society of Cardiology risk stratification algorithm for pulmonary embolism in normotensive elderly patients.

Moor, Jeanne; Baumgartner, Christine; Méan, Marie; Stalder, Odile; Limacher, Andreas; Rodondi, Nicolas; Aujesky, Drahomir (2021). Validation of the 2019 European Society of Cardiology risk stratification algorithm for pulmonary embolism in normotensive elderly patients. (In Press). Thrombosis and haemostasis Thieme 10.1055/a-1475-2263

[img] Text
Moor_ThrombHaemost_2021_AAM.pdf - Accepted Version
Restricted to registered users only until 7 April 2022.
Available under License Publisher holds Copyright.

Download (1MB) | Request a copy

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 post-hoc 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 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 PESI (37%), and only 19% as low risk (32% with 2014 ESC or PESI). Discriminatory power for overall mortality was lower with the 2019 ESC algorithm (AUC 63.6%), compared to the 2014 ESC algorithm (AUC 71.5%) or 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.

CONCLUSIONS

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

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine

UniBE Contributor:

Moor, Jeanne Yvonne; Baumgartner, Christine; Stalder, Odile; Limacher, Andreas; Rodondi, Nicolas and Aujesky, Drahomir

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

2567-689X

Publisher:

Thieme

Funders:

[4] Swiss National Science Foundation

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

15 Apr 2021 20:21

Last Modified:

15 Apr 2021 23:35

Publisher DOI:

10.1055/a-1475-2263

PubMed ID:

33823559

BORIS DOI:

10.48350/155838

URI:

https://boris.unibe.ch/id/eprint/155838

Actions (login required)

Edit item Edit item
Provide Feedback