Acute pulmonary embolism: mortality prediction by the 2014 European Society of Cardiology risk stratification model

Becattini, Cecilia; Agnelli, Giancarlo; Lankeit, Mareike; Masotti, Luca; Pruszczyk, Piotr; Casazza, Franco; Vanni, Simone; Nitti, Cinzia; Kamphuisen, Pieter Willem; Vedovati, Maria Cristina; Natale, Maria Grazia De; Konstantinides, Stavros

doi:10.1183/13993003.00024-2016

Cited by 230 publications

(136 citation statements)

References 17 publications

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“…In conclusion, PESI and sPESI may be considered useful tools for the initial evaluation of PE patients, although we believe in agreement with other authors, 25 that further studies are probably required to improve the risk profile of patients at intermediate risk. It is possible that the widespread use of high-sensitivity troponin will increase the number of positive results at presentation 26 and improve its prognostic value.…”

Section: Pulmonary Embolism After the European Society Of Cardiology supporting

confidence: 89%

ANMCO Position Paper: the use of non-vitamin K dependent new oral anticoagulant(s) in pulmonary embolism therapy and prevention

Enea

Roncon

Gulizia

et al. 2017

European Heart Journal Supplements

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The new oral anticoagulants (NOACs) have radically changed the approach to the treatment and prevention of thromboembolic pulmonary embolism. The authors of this position paper face, in succession, issues concerning NOACs, including (i) their mechanism of action, pharmacodynamics, and pharmacokinetics; (ii) the use in the acute phase with the ‘double drug single dose’ approach or with ‘single drug double dose’; (iii) the use in the extended phase with demonstrated efficacy and with low incidence of bleeding events; (iv) the encouraging use of NOACs in particular subgroups of patients such as those with cancer, the ones under- or overweight, with renal insufficiency (creatinine clearance > 30 mL/min), the elderly (>75 years); (v) they propose a possible laboratory clinical pathway for follow-up; and (vi) carry out an examination on the main drug interactions, their potential bleeding risk, and the way to deal with some bleeding complications. The authors conclude that the use of NOACs both in the acute phase and in the extended phase is equally effective to conventional therapy and associated with fewer major bleeding events, which make their use in patients at higher risk of recurrences safer.

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Section: Pulmonary Embolism After the European Society Of Cardiology supporting

confidence: 89%

ANMCO Position Paper: the use of non-vitamin K dependent new oral anticoagulant(s) in pulmonary embolism therapy and prevention

Enea

Roncon

Gulizia

et al. 2017

European Heart Journal Supplements

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“…On the other end of the risk spectrum, as many as 59.8% of patients were classified in the low-risk group using the biomarker-based strategy with an acceptable rate of an adverse outcome (1.0%, 95% CI 0.3-2.3) while only 16% of patients were classified in the low-risk group by the 2014 ESC algorithm; none (95% CI 0.0-2.7) of these patients had an adverse outcome. Of note, because hsTnT and NT-proBNP were measured in all patients, the number of patients reclassified from low risk to intermediate-low risk might have been higher than in real-world scenarios [19]. Although routine performance of imaging or laboratory testing in the presence of a sPESI of 0 is not considered necessary by current ESC guidelines [1], evidence is accumulating that especially younger PE patients with fewer comorbidities might be misclassified as low risk if further assessment of RV (dys)function is withheld [20].…”

Section: Normotensive Patients With Acute Pe N=843mentioning

confidence: 98%

Prognostic impact of copeptin in pulmonary embolism: a multicentre validation study

Hellenkamp¹,

Pruszczyk

Jiménez

et al. 2018

Eur Respir J

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To externally validate the prognostic impact of copeptin, either alone or integrated in risk stratification models, in pulmonary embolism (PE), we performed a analysis of 843 normotensive PE patients prospectively included in three European cohorts.Within the first 30 days, 21 patients (2.5%, 95% CI 1.5-3.8) had an adverse outcome and 12 (1.4%, 95% CI 0.7-2.5) died due to PE. Patients with copeptin ≥24 pmol·L had a 6.3-fold increased risk for an adverse outcome (95% CI 2.6-15.5, p<0.001) and a 7.6-fold increased risk for PE-related death (95% CI 2.3-25.6, p=0.001). Risk classification according to the 2014 European Society of Cardiology (ESC) guideline algorithm identified 248 intermediate-high-risk patients (29.4%) with 5.6% (95% CI 3.1-9.3) at risk of adverse outcomes. A stepwise biomarker-based risk assessment strategy (based on high-sensitivity troponin T, N-terminal pro-brain natriuretic peptide and copeptin) identified 123 intermediate-high-risk patients (14.6%) with 8.9% (95% CI 4.5-15.4) at risk of adverse outcomes. The identification of patients at higher risk was even better when copeptin was measured on top of the 2014 ESC algorithm in intermediate-high-risk patients (adverse outcome OR 11.1, 95% CI 4.6-27.1, p<0.001; and PE-related death OR 13.5, 95% CI 4.2-43.6, p<0.001; highest risk group all other risk groups). This identified 85 patients (10.1%) with 12.9% (95% CI 6.6-22.0) at risk of adverse outcomes and 8.2% (95% CI 3.4-16.2) at risk of PE-related deaths.Copeptin improves risk stratification of normotensive PE patients, especially when identifying patients with an increased risk of an adverse outcome.

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“…Hypovolemic shock patients tend to do well, with mortality rates under 10% (10). Obstructive shock includes disparate underlying conditions (i.e., cardiac tamponade, pulmonary embolism), occurs less frequently and is less well studied, making outcome estimates difficult (11, 12). …”

Section: Shock Definition and Epidemiologymentioning

confidence: 99%

Cardiopulmonary monitoring of shock

Simmons¹,

Ventetuolo

2017

Current Opinion in Critical Care

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Purpose of review We will briefly review the classification of shock and the hallmark features of each sub-type. Available modalities for monitoring shock patients will be discussed, along with evidence supporting the use, common pitfalls and practical considerations of each method. Recent findings As older, invasive monitoring methods such as the pulmonary artery catheter have fallen out of favor, newer technologies for cardiac output estimation, echocardiography, and non-invasive tests such as passive leg raising have gained popularity. Newer forms of minimally invasive or noninvasive monitoring (such as pulse-contour analysis or chest bioreactance) show promise but will need further investigation before they are considered validated for practical use. There remains no “ideal” test or standard of care for cardiopulmonary monitoring of shock patients. Summary Shock and its underlying etiologies are potentially reversible causes of morbidity and mortality if appropriately diagnosed and managed. Older methods of invasive monitoring have significant limitations but can still be critical for managing shock in certain patients and settings. Newer methods are easier to employ, but further validation is needed. Multiple modalities along with careful clinical assessment are often useful in distinguishing shock sub-types. Best practice standards for monitoring should be based on institutional expertise.

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Acute pulmonary embolism: mortality prediction by the 2014 European Society of Cardiology risk stratification model

Cited by 230 publications

References 17 publications

ANMCO Position Paper: the use of non-vitamin K dependent new oral anticoagulant(s) in pulmonary embolism therapy and prevention

ANMCO Position Paper: the use of non-vitamin K dependent new oral anticoagulant(s) in pulmonary embolism therapy and prevention

Prognostic impact of copeptin in pulmonary embolism: a multicentre validation study

Cardiopulmonary monitoring of shock

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