Abstract | AIMS: Patients with acute pulmonary embolism (PE) at low risk for short-term death are candidates for home treatment or short- hospital stay. We aimed at determining whether the assessment of right ventricle dysfunction (RVD) or elevated troponin improves identification of low-risk patients over clinical models alone. METHODS AND RESULTS: Individual patient data meta-analysis of studies assessing the relationship between RVD or elevated troponin and short-term mortality in patients with acute PE at low risk for death based on clinical models ( Pulmonary Embolism Severity Index, simplified Pulmonary Embolism Severity Index or Hestia). The primary study outcome was short-term death defined as death occurring in hospital or within 30 days. Individual data of 5010 low-risk patients from 18 studies were pooled. Short-term mortality was 0.7% [95% confidence interval (CI) 0.4-1.3]. RVD at echocardiography, computed tomography or B-type natriuretic peptide (BNP)/ N-terminal pro BNP ( NT-proBNP) was associated with increased risk for short-term death (1.5 vs. 0.3%; OR 4.81, 95% CI 1.98-11.68), death within 3 months (1.6 vs. 0.4%; OR 4.03, 95% CI 2.01-8.08), and PE-related death (1.1 vs. 0.04%; OR 22.9, 95% CI 2.89-181). Elevated troponin was associated with short-term death (OR 2.78, 95% CI 1.06-7.26) and death within 3 months (OR 3.68, 95% CI 1.75-7.74). CONCLUSION: RVD assessed by echocardiography, computed tomography, or elevated BNP/ NT-proBNP levels and increased troponin are associated with short-term death in patients with acute PE at low risk based on clinical models. RVD assessment, mainly by BNP/ NT-proBNP or echocardiography, should be considered to improve identification of low-risk patients that may be candidates for outpatient management or short hospital stay.
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Authors | Cecilia Becattini, Giorgio Maraziti, David R Vinson, Austin C C Ng, Paul L den Exter, Benoit Côté, Simone Vanni, Rami Doukky, Danai Khemasuwan, Anthony J Weekes, Thiago Horta Soares, Savas Ozsu, Hernan Polo Friz, Serhat Erol, Giancarlo Agnelli, David Jiménez |
Journal | European heart journal
(Eur Heart J)
Vol. 42
Issue 33
Pg. 3190-3199
(08 31 2021)
ISSN: 1522-9645 [Electronic] England |
PMID | 34179965
(Publication Type: Journal Article, Meta-Analysis)
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Copyright | Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: [email protected]. |
Chemical References |
- Biomarkers
- Peptide Fragments
- Troponin
- Natriuretic Peptide, Brain
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Topics |
- Acute Disease
- Biomarkers
- Heart Ventricles
- Humans
- Natriuretic Peptide, Brain
- Peptide Fragments
- Prognosis
- Pulmonary Embolism
- Risk Assessment
- Troponin
- Ventricular Dysfunction, Right
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