Background
Available studies have already identified age, heart rate (HR) and systolic blood
pressure (SBP) as strong predictors of early mortality in acute pulmonary embolism
(PE).
Material and Methods
One-hundred-seventy patients, with acute PE confirmed on computed tomography angiography
(CTA) were enrolled. Thrombolysis In Myocardial Infarction (TIMI) risk index (TRI)
was calculated using the formula [heart rate (HR) x (AGE/102)/ systolic blood pressure
(SBP)]. Study outcomes were 30-day mortality and/or clinical deterioration.
Results
Receiver operating characteristics (ROC) curve revealed that a TRI ≥45 was highly
specific for both outcomes (AUC 0.91, 95% CI 0.83–0.98, p < 0.0001) with a positive predictive value (PPV) and negative predictive value (NPV)
of 8.3 and 96% for 30-day mortality while PPV and NPV for 30-day mortality and/or
clinical deterioration were 21.1 and 98.2%, respectively. Multivariate regression
analysis showed that TRI ≥45 was an independent predictor of 30-day mortality (O.R.
22.24, 95% CI 2.54–194.10, p = 0.005) independently from positive cTnI and RVD (O.R. 9.57, 95% CI 1.88–48.78, p = 0.007; OR 24.99, 95% CI 2.84–219.48, p = 0.004). Similarly, 30-day mortality and/or clinical deterioration was predicted by
TRI ≥45 (O.R. 11.57, 95% CI 2.36–56.63, p = 0.003) and thrombolysis (3.83, 95% CI 1.04–14.09, p = 0.043), independently from age, RVD and positive cTnI. Cox regression analysis confirmed
the role of TRI as independent predictor for both outcomes. Mantel-Cox analysis showed
that after 30-day follow-up there was a statistically significant difference in the
distribution of survival between patients with and without TRI ≥45 [log rank (Mantel-Cox)
chi-square 17.04, p < 0.0001].
Conclusions
Thrombolysis In Myocardial Infarction (TIMI) risk index (TRI) predicted both 30-days
mortality (all-causes) and/or clinical deterioration in patients with acute PE.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Heart, Lung and CirculationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Pulmonary embolism risk assessment and management.Eur Heart J. 2012; 33: 3014-3022
- Assessing the prognosis of acute pulmonary embolism: tricks of the trade.Chest. 2008; 133: 334-336
- Prognostic factors for pulmonary embolism: the prep study, a prospective multicenter cohort study.Am J Respir Crit Care Med. 2010; 181: 168-173
- A simple risk index for rapid initial triage of patients with ST-elevation myocardial infarction: an In TIME II substudy.Lancet. 2017; 358: 1571-1575
- Heart rate in pulmonary embolism.Intern Emerg Med. 2015; 10: 663-669
- Prognostic value of electrocardiographic findings in hemodynamically stable patients with acute symptomatic pulmonary embolism.Rev Esp Cardiol. 2008; 61: 244-250
- Clinical predictors for fatal pulmonary embolism in 15,520 patients with venous thromboembolism: findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) Registry.Circulation. 2008; 117: 1711-1716
- The risk factor age in normotensive patients with pulmonary embolism: Effectiveness of age in predicting submassive pulmonary embolism, cardiac injury, right ventricular dysfunction and elevated systolic pulmonary artery pressure in normotensive pulmonary embolism patients.Exp Gerontol. 2015; 69: 116-121
- 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism.Eur Heart J. 2014; 35: 3033-3069
- Derivation and validation of a prognostic model for pulmonary embolism.Am J Respir Crit Care Med. 2005; 172: 1041-1046
- Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism.Arch Intern Med. 2010; 170: 1383-1389
- Identification of intermediate-risk patients with acute symptomatic pulmonary embolism.Eur Respir J. 2014; 44: 694-703
- A simple score for rapid risk assessment of non-high-risk pulmonary embolism.Clin Res Cardiol. 2013; 102: 73-80
- Fibrinolysis for patients with intermediate-risk pulmonary embolism.N Engl J Med. 2014; 370: 1402-1411
- Clinical features and short term outcomes of patients with acute pulmonary embolism. The Italian Pulmonary Embolism Registry (IPER).Thromb Res. 2012; 130: 847-852
- Thrombolysis compared with heparin for the initial treatment of pulmonary embolism: a meta-analysis of the randomized controlled trials.Circulation. 2004; 110: 744-749
- Catheter-based reperfusion treatment of pulmonary embolism.Circulation. 2011; 124: 2139-2144
- The meaning and use of the area under a receiver operating characteristic (ROC) curve.Radiology. 1982; 143: 29-36
- Impact of advanced age on the severity of normotensive pulmonary embolism.Heart Vessels. 2015; 30: 647-656
- Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction.Circulation. 2000; 101: 2817-2822
- Haemodynamically unstable pulmonary embolism in the RIETE Registry: systolic blood pressure or shock index?.Eur Respir J. 2007; 30: 1111-1116
- Novel management strategy for patients with suspected pulmonary embolism.Eur Heart J. 2003; 24: 366-376
- Acute pulmonary embolism: external validation of an integrated risk stratification model.Chest. 2013; 144: 1539-1545
- Troponin-based risk stratification of patients with acute nonmassive pulmonary embolism: systematic review and metaanalysis.Chest. 2009; 136: 974-982
- Prognostic role of echocardiography among patients with acute pulmonary embolism and a systolic arterial pressure of 90 mm Hg or higher.Arch Intern Med. 2005; 165: 1777-1781
- Right ventricular enlargement on chest computed tomography: prognostic role in acute pulmonary embolism.Circulation. 2004; 109: 2401-2404
- Multidetector computed tomography for acute pulmonary embolism: diagnosis and risk stratification in a single test.Eur Heart J. 2011; 32: 1657-1663
Article info
Publication history
Published online: April 20, 2017
Accepted:
February 27,
2017
Received in revised form:
February 10,
2017
Received:
March 13,
2016
Identification
Copyright
© 2017 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).