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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
1   Respiratory Department, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain
,
Jose Luis Lobo
2   Respiratory Department, Araba Hospital, Vitoria, Spain
,
Covadonga Fernandez-Golfin
3   Cardiology Department, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain
,
Ana K. Portillo
4   Medicine Department, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain
,
Rosa Nieto
1   Respiratory Department, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain
,
Mareike Lankeit
5   Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Germany
,
Stavros Konstantinides
5   Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Germany
,
Paolo Prandoni
6   Department of Cardiovascular Sciences, Vascular Medicine Unit, University Hospital of Padua, Padua, Italy
,
Alfonso Muriel
7   Biostatistics Unit, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, CIBERESP, Madrid, Spain
,
Roger D. Yusen
8   Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
,
the PROTECT investigators › Author Affiliations Financial support: This study was supported by grants FIS 2008 (PI 08200), FIS 2011 (PI11/00246) and NEUMOMADRID 2014.
Further Information

Publication History

Received: 29 September 2015

Accepted after major revision: 27 January 2015

Publication Date:
29 November 2017 (online)

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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

* The PROTECT investigators are listed in the Appendix.


 

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