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Mareike Lankeit, MD; David Jiménez, MD, PhD
Author and Funding Information

From the Center for Thrombosis and Hemostasis (Dr Lankeit), Johannes Gutenberg University; and the Respiratory Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria.

Correspondence to: David Jiménez, MD, PhD, Respiratory Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria, Colmenar Rd, Km 9.100, Madrid, Spain 28034; e-mail: djc_69_98@yahoo.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(3):873. doi:10.1378/chest.12-2686
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To the Editor:

We thank Drs Thapamagar and Mallareddy for their thoughtful comments and careful review of our recent study in CHEST.1 As described in “Study Outcomes” in the “Materials and Methods” section of our study, the secondary outcome was defined as the combined end point of all-cause mortality, objectively confirmed nonfatal symptomatic recurrent VTE, or nonfatal major bleeding.

Overall, in our study1 of 526 patients with acute symptomatic pulmonary embolism, 30-day all-cause mortality was 7.6% (40 of 526; 95% CI, 5.3% to 9.9%), and 21 patients suffered nonfatal symptomatic recurrent VTE or nonfatal major bleeding. Thus, the secondary end point was reached by 11.6% (95% CI, 8.9% to 14.3%) of patients (61 of 526). To present more detailed secondary outcomes across the models’ strata in Table 4, the frequencies for reaching the combined secondary end point were given separately for “death of any cause” and “nonfatal VTE recurrence or major bleeding.”

Overall, and as described in the article, 12 of the 207 patients in the European Society of Cardiology low-risk strata (5.8%; 95% CI, 2.6% to 9.0%) met the secondary outcome. Of those, seven patients (3.4%; 95% CI, 0.9% to 5.8%) died, and five patients (2.4%; 95% CI, 0.3% to 4.5%) suffered nonfatal recurrent VTE or major bleeding. We apologize that the definition of secondary outcomes and the more detailed description of those in Table 4 led to confusion. In conclusion, our study adds to the body of evidence that the simplified Pulmonary Embolism Severity Index successfully identifies low-risk patients presenting with acute pulmonary embolism.

References

Lankeit M, Gómez V, Wagner C, et al; on behalf of the Instituto Ramón y Cajal de Investigación Sanitaria Pulmonary Embolism Study Group. A strategy combining imaging and laboratory biomarkers in comparison with a simplified clinical score for risk stratification of patients with acute pulmonary embolism. Chest. 2012;141(4):916-922. [CrossRef] [PubMed]
 

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References

Lankeit M, Gómez V, Wagner C, et al; on behalf of the Instituto Ramón y Cajal de Investigación Sanitaria Pulmonary Embolism Study Group. A strategy combining imaging and laboratory biomarkers in comparison with a simplified clinical score for risk stratification of patients with acute pulmonary embolism. Chest. 2012;141(4):916-922. [CrossRef] [PubMed]
 
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