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
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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).
