SPC365

CT-EP score: a predictive model of the prognostic value of CT pulmonary angiography in patients with acute pulmonary embolism

Session: Posters (Sessão 5 - Écran 6) - Tromboembolismo pulmonar
Speaker: Vanda Neto

Congress: CPC 2023
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme: 21.7 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure - Other
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Vanda Devesa Neto; João Fiuza; Joana Correia; Gonçalo Ferreira; Nuno Craveiro; Luis Ferreira Santos

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:#333333">Introduction</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:#333333">Pulmonary embolism (PE) is a common and life-threatening disorder associated with significant in-hospital mortality (IHM). Computer tomography pulmonary angiography (CTPA) is the gold standard diagnostic technique in patients with suspected acute PE in emergency departments The aim of the study was&nbsp;to evaluate if a simple and objective score based on CTPA parameters &ndash; CT-EP score -&nbsp;can predict prognosis in&nbsp;acute PE, comparing it to other previously validated scores.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:#333333">Methods</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:#333333">A retrospective analysis of 134 patients admitted for acute PE was performed. Patients with hemodynamic instability at admission were excluded. PESI score was calculated for each patient, and the newly designed CT-EP score (variables: right ventricle/left ventricle ratio, presence of reflux of contrast into inferior vena cava, pulmonary artery/aorta ratio, and flattening of the interventricular septum) was calculated for each patient (range 0-11 points), after identifying the variables significantly associated with IHM (points attributed for each variable according to odds ratio). ROC curve analysis was performed to evaluate the predictive value of the different scores. Cox regression analysis and Kaplan-Meyer survival plots were used to assess 1-month mortality (1MM). </span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:#333333">Results</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:#333333">Mean age was 62&plusmn;17y; 63% were female; 16% and 54% of patients, respectively, had an identifiable major or minor precipitating factor for PE. 33% had low-risk PE, 58% intermediate-low-risk PE, and 9% intermediate-high-risk PE, as defined by current guidelines. Mean PESI&nbsp;was 94&plusmn;38, and mean CT-EP score was 5.2&plusmn;3.2. 1MM was 9%. ROC curve analysis revealed that CT-EP score had the best predictive performance for 1MM compared to PESI score (AUC 0.852; p=0.04 vs. AUC 0.661; p=0.03, respectively). The optimal cut-off point for 1MM using CT-EP score was 8.5 (sensitivity 70%, specificity 85%). When stratified by risk categories (high risk if CT-EP score &gt;9 and low risk if CT-EP &le;8), we observed a significantly higher 1MM in high-risk patients compared with lower-risk patients (43% vs. 7%, respectively; p&lt;0.01; OR 9.8). Kaplan Meyer analysis by risk subgroup revealed significantly lower median time 1MM in patients with high-risk CT-EP score (14.7&plusmn;7 days vs. 2.5&plusmn;0.7 days, &chi;2=4.923, p=0.03) compared with low-risk patients. Cox-regression analysis demonstrated that CT-EP score remained a significant independent prognosis marker for 1MM after adjustment for other variables, such as renal function, pulmonary disease, and PESI score.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:#333333">Conclusion: </span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif"><span style="color:#333333">In conclusion, the CT-EP score is a simple and objective score based on CTPA parameters that can be used in daily practice to predict 1-month mortality in patients hospitalized due to acute PE. In addition, since CTPA is the gold-standard technique for diagnosing acute PE, this score can be quickly applied in the emergency department and be a tool for defining subgroups with higher mortality risk.</span></span></span></span></span></p>