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Risk assessment in patients with intermediate to high-risk pulmonary embolism: can the validated scores help predict the necessity for reperfusion therapy?
Session:
SESSÃO DE POSTERS 58 – TROMBOEMBOLISMO
Speaker:
Francisco Rodrigues Dos Santos
Congress:
CPC 2025
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
14. Acute Cardiac Care
Subtheme:
14.6 Acute Cardiac Care – Other
Session Type:
Cartazes
FP Number:
---
Authors:
Francisco Rodrigues Dos Santos; Mariana Duarte Almeida; Gonçalo Ferreira; João Gouveia Fiuza; Oliver Kungel; Vanda Devesa Neto; António Costa; Inês Fiuza Pires
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt">Background:</span></strong> <span style="background-color:white"><span style="color:black">Pulmonary embolism (PE) remains associated with unfavourable outcomes and high mortality rates. Early identification of high-risk patients is therefore crucial to ensure close monitoring and timely, appropriate therapeutic management. Several risk scores have been developed to facilitate risk stratification, especially predicting mortality rates. This study aims to compare previous validated PE risk scores and if they can predict the need for reperfusion therapy (RT) in patients with </span></span>intermediate to high-risk<span style="background-color:white"><span style="color:black"> PE. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt">Methods:</span></strong> Retrospective analysis of all patients admitted to Cardiology department between January 2018 and November 2024 due to intermediate to high-risk pulmonary embolism (PE). Data was collected to calculate scores with clinical evidence for predicting mortality: Pulmonary Embolism Severity Index (PESI), Pulmonary Embolism Risk Score for Mortality in Computed Tomographic Pulmonary Angiography-confirmed Patients (PERFORM) and the Modified Fast Score (MFS). These scores were applied and their ability to predict the need for RT. Comparison of ROC curves were used for the comparative evaluation of the different scores.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-family:"Calibri",sans-serif">Results:</span></strong><span style="font-family:"Calibri",sans-serif"> 154 patients were included; </span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">mean age was 62.7±18.4</span></span> <span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">years, 61% (n=94) were female. The 1-month mortality rate was 18% (n=32). 51% (n=78) were submitted to RT, 21% (n=16) of those submitted to catheter-directed therapies. Identification of higher risk patients by each score was: MFS 47.4% patients (n=73), PERFORM 68.2% (n=105) and PESI 28.6% (n=44) patients. The ability to predict need for reperfusion therapy was significant by PERFORM (43.5% vs 7.1%; χ²=20.4, p<0.01) and MFS (32.5% vs 18.2%; χ²=16.6, p<0.01). PESI (14.3% vs 36.4%, p=0.49) was not associated with need for RT. ROC curve analysis showed that AUC for PERFORM, MFS, and PESI for predicting RT were 0.647, 0.674, and 0.483, respectively, indicating superior predictive capacity of PERFORM and MFS compared to PESI (p<0.01 and p=0.01, respectively) (Figure 1).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt">Conclusion:</span></strong> PERFORM and MFS demonstrated superior predictive capacity for the need for RT compared to PESI score, but the predictive capacity was only satisfactory. Although previously validated to predict mortality, theses scores have not high predicting capacity do predict RT in these recent cohort. Systemic thrombolysis is the first-line reperfusion therapy, but due to contraindications and major bleeding concerns, the use of catheter-directed therapies is increasing as a suitable alternative, allowing more patients to being submitted to RT. Therefore, it becomes even more challenging applying standardized scores in heterogenic clinical scenarios.</span></span></p>
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