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Original Research |

A Strategy Combining Imaging and Laboratory Biomarkers in Comparison With a Simplified Clinical Score for Risk Stratification of Patients With Acute Pulmonary EmbolismPrognostic Models in Pulmonary Embolism

Mareike Lankeit, MD; Vicente Gómez, MD; Carolin Wagner, MD; Drahomir Aujesky, MD; Mónica Recio, MD; Sem Briongos, MD; COL Lisa K. Moores, MD, MC, USA,FCCP; Roger D. Yusen, MD; Stavros Konstantinides, MD; David Jiménez, PhD; on behalf of the Instituto Ramón y Cajal de Investigación Sanitaria Pulmonary Embolism Study Group *
Author and Funding Information

From the Department of Cardiology and Pulmonology (Drs Lankeit and Konstantinides), University of Göttingen, Göttingen, Germany; the Medicine Department (Dr Gómez), the Respiratory Department (Drs Wagner and Jiménez), and the Cardiology Department (Drs Recio and Briongos), Ramón y Cajal Hospital, IRYCIS, Madrid, Spain; the Division of General Internal Medicine (Dr Aujesky), Bern University Hospital, Bern, Switzerland; the F. Edward Hebert School of Medicine (Dr Moores), Uniformed Services University, Bethesda, MD; the Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences (Dr Yusen), Washington University School of Medicine, St. Louis, MO; and the Department of Cardiology (Dr Konstantinides), Democritus University of Thrace, Alexandroupolis, Greece.

Correspondence to: David Jiménez, PhD, Respiratory Department and Medicine Department, Ramón y Cajal Hospital and Alcalá de Henares University, 28034 Madrid, Spain; e-mail: djc_69_98@yahoo.com


A complete list of participants is located in e-Appendix 1.

Drs Lankeit and Gómez contributed equally to the manuscript.

Funding/Support: This work has been supported in part by Instituto de Salud Carlos III [FIS 08/0200], Sociedad Española de Neumología y Cirugía Torácica [SEPAR 2008], and NEUMOMADRID 2010.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(4):916-922. doi:10.1378/chest.11-1355
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Background:  This study aimed to assess the performance of two prognostic models—the European Society of Cardiology (ESC) model and the simplified Pulmonary Embolism Severity Index (sPESI)—in predicting short-term mortality in patients with pulmonary embolism (PE).

Methods:  We compared the test characteristics of the ESC model and the sPESI for predicting 30-day outcomes in a cohort of 526 patients with objectively confirmed PE. The primary end point of the study was all-cause mortality. The secondary end point included all-cause mortality, nonfatal symptomatic recurrent VTE, or nonfatal major bleeding.

Results:  Overall, 40 of 526 patients died (7.6%; 95% CI, 5.3%-9.9%) during the first month of follow-up. The sPESI classified fewer patients as low risk (31% [165 of 526], 95% CI, 27%-35%) compared with the ESC model (39% [207 of 526], 95% CI, 35% to 44%; P < .01). Importantly however, low-risk patients based on the sPESI had no 30-day mortality compared with 3.4% (95% CI, 0.9-5.8) in low-risk patients by the ESC model. The secondary end point occurred in 1.8% of patients in the sPESI low-risk and 5.8% in the ESC low-risk group (difference, 4.0 percentage points; 95% CI, 0.2-7.8). The prognostic ability of the ESC model remained significant in the subgroup of patients at high-risk according to the sPESI model (OR 1.95, 95% CI, 1.41 to 2.71, P < .001).

Conclusions:  Both the sPESI and the ESC model successfully predict 30-day mortality after acute symptomatic PE, but exclusion of an adverse early outcome does not appear to require routine imaging procedures or laboratory biomarker testing.


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