Effectiveness of prognosticating pulmonary embolism using the ESC algorithm and the Bova score

David Jimenez; Jose Luis Lobo; Covadonga Fernandez-Golfin; Ana K. Portillo; Rosa Nieto; Mareike Lankeit; Stavros Konstantinides; Paolo Prandoni; Alfonso Muriel; Roger D. Yusen; the PROTECT investigators; on behalf of the

doi:10.1160/TH15-09-0761

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2016; 115(04): 827-834
DOI: 10.1160/TH15-09-0761

Stroke, Systemic or Venous Thromboembolism

Schattauer GmbH

Effectiveness of prognosticating pulmonary embolism using the ESC algorithm and the Bova score

David Jimenez

¹Respiratory Department, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain

,

Jose Luis Lobo

²Respiratory Department, Araba Hospital, Vitoria, Spain

,

Covadonga Fernandez-Golfin

³Cardiology Department, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain

,

Ana K. Portillo

⁴Medicine Department, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain

,

Rosa Nieto

¹Respiratory Department, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain

,

Mareike Lankeit

⁵Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Germany

,

Stavros Konstantinides

⁵Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Germany

,

Paolo Prandoni

⁶Department of Cardiovascular Sciences, Vascular Medicine Unit, University Hospital of Padua, Padua, Italy

,

Alfonso Muriel

⁷Biostatistics Unit, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, CIBERESP, Madrid, Spain

,

Roger D. Yusen

⁸Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri, USA

,

the PROTECT investigators

› Author Affiliations

Abstract

Summary

The prognostic value of the European Society of Cardiology (ESC) 2014 algorithm and the Bova score has lacked adequate validation. According to the ESC 2014 guidelines and the Bova score, we retrospectively risk stratified normotensive patients with PE who were enrolled in the PROTECT study. This study used a complicated course (which consisted of death from any cause, haemodynamic collapse, or recurrent PE) as the primary endpoint, and follow-up occurred through 30 days after the PE diagnosis. Of 848 patients, 37 % had a sPESI of 0 and 5 (1.6 %; 95 % confidence interval [CI], 0.5-3.7 %) experienced a complicated course. Of 143 patients with a sPESI of 0 points and negative computed tomographic pulmonary angiography (CTPA) for right ventricle (RV) dysfunction, three (2.1 %; 95 % CI, 0.4-6.0 %) experienced a complicated course. Four hundred seventy-eight (56 %) patients with a sPESI ≥ 1 had echocardiographic evidence of RV dysfunction or elevated troponin level or none, and 48 (10 %, 95 % CI, 7.5-13.1 %) experienced a complicated course. Fifty-seven (6.7 %) patients with a sPESI ≥ 1 had echocardiographic RV dysfunction and elevated troponin level, and 10 (17.5 %; 95 % CI, 8.8-29.9 %) experienced a complicated course, compared to 21.6 % (8 of 37 patients, 21.6 %; 95 % CI, 9.8-38.2 %) in Bova risk class III. In conclusion, the ESC 2014 prognostic algorithm is effective in the risk stratification of normotensive patients with PE. Use of CTPA did not improve the ability for identification of low-risk PE. Bova risk scoring did not significantly improve identification of intermediate-high risk PE.

Jiménez et al. Validation of the ESC 2014 prognostication algorithm

Keywords

Pulmonary embolism - prognosis - clinical scores - biomarkers - echo-cardiography

Full Text

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