Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy
Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy.
Eur Respir J. 2016 Sep;48(3):780-6. doi: 10.1183/13993003.00024-2016. Epub 2016 May 12.
The European Society of Cardiology (ESC) has proposed an updated risk stratification model for death in patients with acute pulmonary embolism based on clinical scores (Pulmonary Embolism Severity Index (PESI) or simplified PESI (sPESI)), right ventricle dysfunction (RVD) and elevated serum troponin (2014 ESC model).We assessed the ability of the 2014 ESC model to predict 30-day death after acute pulmonary embolism. Consecutive patients with symptomatic, confirmed pulmonary embolism included in prospective cohorts were merged in a collaborative database. Patients' risk was classified as high (shock or hypotension), intermediate-high (RVD and elevated troponin), intermediate-low (RVD or increased troponin or none) and low (sPESI 0). Study outcomes were death and pulmonary embolism-related death at 30 days.Among 906 patients (mean±sd age 68±16, 489 females), death and pulmonary embolism-related death occurred in 7.2% and 4.1%, respectively. Death rate was 22% in "high-risk" (95% CI 14.0-29.8), 7.7% in "intermediate-high-risk" (95% CI 4.5-10.9) and 6.0% in "intermediate-low-risk" patients (95% CI 3.4-8.6). One of the 196 "low-risk" patients died (0.5%, 95% CI 0-1.0; negative predictive value 99.5%).By using the 2014 ESC model, RVD or troponin tests would be avoided in about 20% of patients (sPESI 0), preserving a high negative predictive value. Risk stratification in patients at intermediate risk requires further improvement.
欧洲心脏病学会 (ESC) 提出了一种基于临床评分（肺栓塞严重指数 (PESI) 或简化 PESI (sPESI)）、右心室功能障碍 (RVD) 和血清肌钙蛋白升高的急性肺栓塞患者死亡的更新风险分层模型。我们评估了 2014 ESC 模型预测急性肺栓塞后 30 天死亡的能力。连续纳入前瞻性队列的有症状、确诊肺栓塞患者被合并到一个协作数据库中。将患者的风险分为高危（休克或低血压）、中高危（RVD 和肌钙蛋白升高）、中低危（RVD 或肌钙蛋白升高或无）和低危（sPESI 0）。研究结局为 30 天内死亡和肺栓塞相关死亡。在 906 例患者（平均年龄 68±16 岁，489 例女性）中，分别有 7.2%和 4.1%发生死亡和肺栓塞相关死亡。“高危”患者的死亡率为 22%（95%CI 14.0-29.8），“中高危”患者为 7.7%（95%CI 4.5-10.9），“中低危”患者为 6.0%（95%CI 3.4-8.6）。196 例“低危”患者中只有 1 例死亡（0.5%，95%CI 0-1.0；阴性预测值 99.5%）。使用 2014 ESC 模型，约 20%的患者（sPESI 0）可避免进行 RVD 或肌钙蛋白检查，保留高阴性预测值。对于处于中间风险的患者，风险分层需要进一步改进。
