Cardiovascular Risk Assessment of Pulmonary Embolism With the GRACE Risk Score

Paiva, Luís; Providência, Rui; Barra, Sérgio; Faustino, Ana; Botelho, Ana; Marques, António Leitão

doi:10.1016/j.amjcard.2012.10.020

Cited by 25 publications

(16 citation statements)

References 20 publications

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“…As mentioned in the GRACE score and other clinical rules (LR-PED), atrial fibrillation may be an independent predictor of 6-month mortality in patients with acute pulmonary embolism; however, these data should be tested and validated in prospective studies using larger cohorts (28, 29). In our study, although the prevalence of atrial fibrillation was 37.9%, the difference between the survivor and non-survivor groups was not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Chronic kidney disease: Prognostic marker of nonfatal pulmonary thromboembolism

Ouatu¹,

Floria²,

Ionescu³

et al. 2015

Anatol J Cardiol

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Objective:Renal dysfunction is associated with increased cardiovascular morbidity and mortality. The alteration in renal function as a marker of mortality in pulmonary thromboembolism (PTE) has not been studied extensively.Methods:Four hundred four consecutive patients diagnosed with non-high-risk PTE (without cardiogenic shock or blood pressure <90 mm Hg) were prospectively enrolled in the study between 2005-2010. Kidney function, based on glomerular filtration rate (GFR), calculated by the simplified modification in diet in renal disease (MDRD) equation (sMDRD); troponin I; B-type natriuretic peptide (BNP); and echocardiographic markers of right ventricular (RV) function were determined in survivors versus non-survivors after a 2-year follow-up.Results:GFR was significantly lower in non-survivors than in survivors: 51.85±19.08 mL/min/1.73 m2 and 71.65±23.21 mL/min/1.73 m2, respectively (p=0.000). The highest 2-year mortality rate (20%) was recorded in patients with moderate renal dysfunction associated with RV dysfunction. Using multivariate analysis, we found that GFR is an independent predictor of 2-year mortality (OR 0.973, 95% CI: 0.959-0.987, p=0.000), besides troponin I, dyslipidemia, acceleration time of pulmonary ejection, pericardial effusion, and BNPConclusion:The association of renal dysfunction with right ventricular dysfunction in patients with non-fatal pulmonary thromboembolism resulted in high mortality. Renal dysfunction, assessed by glomerular filtration rate, may be used in the risk stratification of patients with non-high-risk pulmonary thromboembolism, besides troponin I, BNP and right ventricle echocardiographic dysfunction markers.

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Section: Discussionmentioning

confidence: 99%

Chronic kidney disease: Prognostic marker of nonfatal pulmonary thromboembolism

Ouatu¹,

Floria²,

Ionescu³

et al. 2015

Anatol J Cardiol

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“…Клиническая универсальность шкалы GRACE была продемонстрирована Paiva LV, et al в ходе проведения ретроспективного обсервационного когортного исследования, в котором приняло участие 206 пациентов, последовательно поступивших с ТЭЛА [14]. По сравнению с исследованием Paiva LV, наша исследуемая группа включала больше пациентов (383 против 206 человек), была моложе (57,4±14,4 лет против 70,3±15,6 лет), имела в своем составе меньше гемодинамически нестабильных пациентов (5,48% против 7,3%), однако тромболизис был проведен у большего числа больных (22,3% против 9,2%).…”

Section: Discussionunclassified

“…Одновременно с оценкой индекса PESI для стратификации риска использовалась шкала GRACE, при этом к низкому риску относили пациентов, набравших ≤113 баллов, а к высокому ->113 баллов [14].…”

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“…Шкала GRACE никогда не использовалась для оценки прогноза пациентов с ТЭЛА. Впервые Paiva LV, et al была показана эффективность шкалы GRACE для стратификации риска смерти и сердечнососудистых осложнений у пациентов с ТЭЛА [14]. В ходе исследования не было отмечено никаких неблагоприятных исходов за период госпитализации у пациентов с количеством баллов по шкале GRACE ≤113.…”

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GRACE score in assessing the risk of hospital outcomes in patients with pulmonary embolism

Mullova¹,

Cherepanova²,

Павлова³

et al. 2018

Russ J Cardiol

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Aim. To compare the PESI and GRACE scores in assessing the risk of hospital outcomes in patients with pulmonary embolism.Material and methods. The study included 383 patients with pulmonary embolism (PE), hospitalized during the period of April 4, 2003 on September 18, 2014; 190 (49,6%) are men, the average age is 57,4 years±14,4 years. We considered the patient’s anamnesis, complaints, results of biochemical and instrumental tests, as well as the treatment carried out to the patients.Results. According to the risk stratification of PESI score, 86 (22,5%) patients had a very low risk of death, 88 (22,9%) had a low risk, 94 (24,5%) had an intermediate risk, 60 (15,%) — high risk and 55 (14,4%) patients have a very high risk. The combination of three ECG signs (SI-QIII, right bundle branch block and T-wave inversion in V1-V3) was significantly more common in patients with a very high PE risk — 14,5% (p=0,025). The most reliable sign of the most echographic (echoCG) criteria was dilatation of right ventricle (RV) (p=0,009) in a group of patients with a very high PE risk. According to the GRACE scale, 112 (29,2%) patients were assigned to the low risk group, and 271 (70,8%) patients — to the high risk group. ECG signs were observed more frequently in the high risk group: SI-QIII, T-wave inversion in III, V1-V3 leads, right bundle branch block (p<0,05). Pulmonary hypertension and RV dilatation according to echoCG prevailed in the high risk group (98,4% and 85,1%, respectively), p<0,05. The minimum value of points on the GRACE score for the deceased patients was 118 points. The GRACE scale showed high predictive ability with a sensitivity of 96% and a specificity of 63% (AUC=0,811, CI 95% 0,0738-0,884). However, the PESI score had a slightly greater predictive value with a sensitivity of 100% and a specificity of 53% (AUC=0,879 compared with AUC=0,811 for the GRACE scale). Analysis of the PESI and GRACE scores showed a moderate correlation between them (r=0,668).Conclusion. The GRACE score showed a high predictive value for adverse outcomes in PE patients with a sensitivity of 96% and a specificity of 63%. The minimum score on the GRACE score for deceased patients was 118 points.

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“…The clinical versatility of the Global Registry of Acute Cardiac Events (GRACE) risk score has been demonstrated by Paiva et al in their retrospective observational cohort study of 206 consecutive PE patients. 37 Although widely used to estimate mortality risk in patients with a myocardial infarction, the authors assessed its applicability in PE, suggesting that it could predict improve risk stratification when compared with the Geneva score, the shock index, the European Society of Cardiology score, and simplified PESI. Importantly, no adverse outcomes were observed in patients with a GRACE score ≤113, suggesting potential utility in the selection of truly low-risk individuals entitled to outpatient treatment.…”

Section: Identifying Truly Low-risk Patientsmentioning

confidence: 99%

A Review on State‐of‐the‐Art Data Regarding Safe Early Discharge Following Admission for Pulmonary Embolism: What Do We Know?

Barra

Paiva

Providência

et al. 2013

Clinical Cardiology

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Background Although most patients with acute pulmonary embolism (PE) remain hospitalized during initial therapy, some may be suitable for partial or complete outpatient management, which may have a significant impact on healthcare costs. Hypothesis This article reviews the state‐of‐the‐art data regarding recognition of very‐low‐risk PE patients who are potentially eligible for outpatient treatment, along with the safety, management, and cost‐effectiveness of this strategy. We propose an algorithm based on collected data that may be useful/practical for identifying patients truly eligible for early discharge. Methods Comprehensive review of scientific data collected from the MEDLINE and Cochrane databases. Studies selected based on potential scientific interest. Qualitative information extracted regarding feasibility, safety, and cost‐effectiveness of outpatient treatment, postdischarge management, and selection of truly low‐risk patients. Results Early discharge of low‐risk patients seems feasible, safe, and particularly cost‐effective. Several risk scores have been developed and/or tested as prediction tools for the recognition of low‐risk individuals: the Pulmonary Embolism Severity Index (PESI), simplified PESI, Hestia criteria, Geneva score, the Low‐Risk Pulmonary Embolism Decision rule, and the Global Registry of Acute Cardiac Events, among others. PESI is the most well‐validated model, offering the safest approach at the current time, especially when combined with additional parameters such as troponin I, N‐terminal prohormone of brain natriuretic peptide, and echocardiographic markers of right‐ventricular dysfunction. Conclusions Recognition of truly low‐risk patients entitled to early hospital discharge and outpatient treatment is possible with current risk‐stratification schemes along with selected prognostic parameters, and it may have a colossal impact on healthcare costs.

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Cardiovascular Risk Assessment of Pulmonary Embolism With the GRACE Risk Score

Cited by 25 publications

References 20 publications

Chronic kidney disease: Prognostic marker of nonfatal pulmonary thromboembolism

Chronic kidney disease: Prognostic marker of nonfatal pulmonary thromboembolism

GRACE score in assessing the risk of hospital outcomes in patients with pulmonary embolism

A Review on State‐of‐the‐Art Data Regarding Safe Early Discharge Following Admission for Pulmonary Embolism: What Do We Know?

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