Identification of hemodynamically stable patients with acute pulmonary embolism at high risk for death: external validation of different models
Cecilia Becattini, Maria Cristina Vedovati, Sílvia Colombo, Simone Vanni, Maurizio Giuseppe Abrignani, Angela Beatrice Scardovi, Alessandra Marrazzo, Matteo Borselli, Marco Barchetti, Andrea Fabbri, Francesco Dentali, Aldo P. Maggioni, Giancarlo Agnelli, Michele Massimo Gulizia, Cecilia Becattini, Michele Massimo Gulizia, Giancarlo Agnelli, Francesco Dentali, Andrea Di Lenarda, Iolanda Enea, Andrea Fabbri, Aldo P. Maggioni, Fulvio Pomero, Maria Pia Ruggeri, Cecilia Becattini, Donata Lucci, Aldo P. Maggioni, Maria Cristina Vedovati, Michele Duranti, Francesco Guercini, Paolo Groff, Melina Verso, Gianna Fabbri, Martina Savoia, Donata Lucci, Ester Baldini, B Bartolomei Mecatti, Francesca Bianchini, Martina Ceseri, Gianna Fabbri, Lucio Gonzini, Marco Gorini, Andrea Lorimer, G Orsini, Martina Tricoli, Ludovica Anna Cimini, Cecilia Becattini, Giancarlo Agnelli, Valeriana Cesarini, Marco Sanna, Guglielmina Pepe, Cristina Marchetti, María Roldán, Luana Lenzi, Susanna Cozzio, P. Tomio, M. Diamanti, Anna Beltrame, Letizia Glinski, Martina Treleani, Alessandro Coppa, Simone Vanni, Paola Bartalucci, A. Taccone, C. Costacurta, P. Bortolotti, Marino Bortolussi, Massimiliano De Vecchi, F Zanardi, I. Greco, Roberto Cosentini, Riccardo Gerloni, Nicola Artusi, Franco Cominotto, Ugo Giulio Sisto, Claudio Picariello, Loris Roncon, A. Maddalozzo, Cinzia Nitti, Francesca Riccomi, Márcia Liane Buzzo, Giorgio Bassanelli, Stefano Savonitto, Alessandra Bianchi, Claudio Bilato, Ilaria Lobascio, Claudia Dalla Valle, Daniela Paola Pomata, Fabrizio Giostra, Anna Laura Tinuper, Beniamino Zalunardo, A. Visonà, Chiara Panzavolta, Anna Novelli, Alessandro Bertini, C.O. Granai, Sílvia Colombo, E. Periti, Luca Bonacchini, Maurizio Giuseppe Abrignani
Abstract
BACKGROUND: The optimal strategy for identification of hemodynamically stable patients with acute pulmonary embolism (PE) at risk for death and clinical deterioration remains undefined. OBJECTIVES: We aimed to assess the performances of currently available models/scores for identifying hemodynamically stable patients with acute, symptomatic PE at risk of death and clinical deterioration. METHODS: This was a prospective multicenter cohort study including patients with acute PE (NCT03631810). Primary study outcome was in-hospital death within 30 days or clinical deterioration. Other outcomes were in-hospital death, death, and PE-related death, all at 30 days. We calculated positive and negative predictive values, c-statistics of European Society of Cardiology (ESC)-2014, ESC-2019, Pulmonary Embolism Thrombolysis (PEITHO), Bova, Thrombo-embolism lactate outcome study (TELOS), fatty acid binding protein, syncope and tachicardia (FAST), and National Early Warning Scale 2 (NEWS2) for the study outcomes. RESULTS: In 5036 hemodynamically stable patients with acute PE, positive predictive values for the evaluated models/scores were all below 10%, except for TELOS and NEWS2; negative predictive values were above 98% for all the models/scores, except for FAST and NEWS2. ESC-2014 and TELOS had good performances for in-hospital death or clinical deterioration (c-statistic of 0.700 and 0.722, respectively), in-hospital death (c-statistic of 0.713 and 0.723, respectively), and PE-related death (c-statistic of 0.712 and 0.777, respectively); PEITHO, Bova, and NEWS2 also had good performances for PE-related death (c-statistic of 0.738, 0.741, and 0.742, respectively). CONCLUSION: In hemodynamically stable patients with acute PE, the accuracy for identification of hemodynamically stable patients at risk for death and clinical deterioration varies across the available models/scores; TELOS seems to have the best performance. These data can inform management studies and clinical practice.