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White Smoke in the Intermediate risk PE debate – Could POPE be the solution?
Session:
Comunicações Orais - Sessão 12 - Hipertensão Pulmonar
Speaker:
Ana Margarida Martins
Congress:
CPC 2024
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.4 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure - Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Ana Margarida Martins; Ana Beatriz Garcia; Catarina Oliveira; Ana Abrantes; Miguel Raposo; João Fonseca; Catarina Gregório; Beatriz Valente Silva; Miguel Nobre de Menezes; Cláudia Jorge; Fausto J. Pinto
Abstract
<p style="text-align:justify"><span style="font-size:16px"><strong>Introduction:</strong></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="font-size:11pt">Despite a</span><span style="font-size:11pt"><span style="color:#000000"> multitude of innovative therapeutic strategies emerging in the past decade, acute pulmonary embolism (PE) remains a potentially fatal disease. Mortality varies significantly according to risk stratification, substantiating current recommendations to use reperfusion therapy only in hemodynamicall</span>y unstable patients (pts). T<span style="color:#000000">here is an ongoing debate around whether hemodynamically stable</span> pts showing signs of right ventricle dysfunction and myocardial injury (intermediate-high risk PE) may also benefit from reperfusion therapy. While most pts<span style="color:#000000"> in this category typically improve with anticoagulation alone, up to 10% may experience clinical deterioration.</span></span></span></span></p> <p style="text-align:start"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt">Aim </span></strong></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt">Characterize the clinical in-hospital progression of patients with intermediate-risk PE and to evaluate the discriminative efficacy of PE scores in anticipating unfavorable clinical outcomes.</span></span></span></span></p> <p style="text-align:start"> </p> <p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt">Methods</span></strong></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt">We conducted a retrospective observational study in patients admitted with PE classified as intermediate risk in a tertiary center. Clinical, laboratory and ECG data were obtained. The BOVA score, the News score and the Pope score were evaluated. A composite endpoint of in-hospital mortality and use of reperfusion therapy due to hemodynamic deterioration was defined. Predictive abilities of these three scores were compared using area under the receiver operating characteristics (AUC-ROC) curve.</span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt">Results</span></strong></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt">From January 2019 to December 2020, a total of 166 patients were admitted with acute PE, classified as intermediate-risk. The mean age was 71.9 </span><span style="font-size:11pt"><span style="font-family:Symbol">±</span></span><span style="font-size:11pt"> 16.2 years and 57.2% were female. 71.1% of the pts showed bilateral </span></span><span style="font-size:11pt">PE in angioCT. T</span><span style="color:#000000"><span style="font-size:11pt">he composite endpoint of in-hospital mortality and reperfusion therapy due to hemodynamic deterioration occurred in 9.8% of the pts.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt">The median BOVA score was 3 (2-4), the median POPE score was 1 (0-2) and the median News score was 4 (2-6). The ROC curve analysis showed a significant higher discriminative power of POPE sco</span></span><span style="font-size:11pt">re compared to the others scor</span><span style="color:#000000"><span style="font-size:11pt">es (AUC0.856, 95%CI 0.79–.92, p<0.001)(Fig1). C</span></span><span style="font-size:11pt">ompared to pts with a P</span><span style="color:#000000"><span style="font-size:11pt">OPE score </span><span style="font-size:11pt"> 1, the composite endpoint was 4,6 tim</span></span><span style="font-size:11pt">es higher in pts with hig</span><span style="color:#000000"><span style="font-size:11pt">her scores (OR 4.6 95%CI 1.63- 6914, p=0.029)(Fig2). </span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt">Conclusion</span></strong></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt">Despite classification as intermediate risk, these patients displayed a non-negligible in-hospital mortality rate. Close clinical monitoring is warranted in this group of pts and there is pressing need for an early identification of those who might benefit from more than just anticoagulation. In our population POPE score showed to be a simple and accurate tool in predicting those with an unfavorable evolution that could have benefitted from more advanced intervention.</span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"> </p> <p style="text-align:justify"> </p> <p style="text-align:justify"> </p> <p style="text-align:justify"> </p> <p style="text-align:justify"> </p> <p style="text-align:justify"> </p>
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