European Society of Cardiology practice guidelines on acute pulmonary embolism. An American’s commentary and personal perspectives

2009 ◽  
Vol 119 (1-2) ◽  
pp. 6-7
Author(s):  
Samuel Z. Goldhaber
Keyword(s):  
Pulmonary Embolism ◽  
Practice Guidelines ◽  
European Society ◽  
Acute Pulmonary Embolism ◽  
Personal Perspectives ◽  
European Society Of Cardiology

scholarly journals Acute pulmonary embolism: mortality prediction by the 2014 European Society of Cardiology risk stratification model

2016 ◽  
Vol 48 (3) ◽  
pp. 780-786 ◽  
Author(s):  
Cecilia Becattini ◽  
Giancarlo Agnelli ◽  
Mareike Lankeit ◽  
Luca Masotti ◽  
Piotr Pruszczyk ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Risk Stratification ◽  
Negative Predictive Value ◽  
European Society ◽  
Predictive Value ◽  
Acute Pulmonary Embolism ◽  
Risk Stratification Model ◽  
Risk Patients ◽  
European Society Of Cardiology

The European Society of Cardiology (ESC) has proposed an updated risk stratification model for death in patients with acute pulmonary embolism based on clinical scores (Pulmonary Embolism Severity Index (PESI) or simplified PESI (sPESI)), right ventricle dysfunction (RVD) and elevated serum troponin (2014 ESC model).We assessed the ability of the 2014 ESC model to predict 30-day death after acute pulmonary embolism. Consecutive patients with symptomatic, confirmed pulmonary embolism included in prospective cohorts were merged in a collaborative database. Patients’ risk was classified as high (shock or hypotension), intermediate-high (RVD and elevated troponin), intermediate-low (RVD or increased troponin or none) and low (sPESI 0). Study outcomes were death and pulmonary embolism-related death at 30 days.Among 906 patients (mean±sd age 68±16, 489 females), death and pulmonary embolism-related death occurred in 7.2% and 4.1%, respectively. Death rate was 22% in “high-risk” (95% CI 14.0–29.8), 7.7% in “intermediate-high-risk” (95% CI 4.5–10.9) and 6.0% in “intermediate-low-risk” patients (95% CI 3.4–8.6). One of the 196 “low-risk” patients died (0.5%, 95% CI 0–1.0; negative predictive value 99.5%).By using the 2014 ESC model, RVD or troponin tests would be avoided in about 20% of patients (sPESI 0), preserving a high negative predictive value. Risk stratification in patients at intermediate risk requires further improvement.

scholarly journals Validation of the Predictive Model of the European Society of Cardiology for Early Mortality in Acute Pulmonary Embolism

TH Open ◽  
2018 ◽  
Vol 02 (03) ◽  
pp. e265-e271 ◽  
Author(s):  
Massimo Cugno ◽  
Federica Depetri ◽  
Laura Gnocchi ◽  
Fernando Porro ◽  
Paolo Bucciarelli
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
European Society ◽  
Prognostic Model ◽  
Acute Pulmonary Embolism ◽  
Early Mortality ◽  
Risk Category ◽  
High Risk Category ◽  
European Society Of Cardiology ◽  
D Dimer

Background Acute pulmonary embolism (PE) is burdened by high mortality, especially within 30 days from the diagnosis. The development and the validation of predictive models for the risk of early mortality allow to differentiate patients who can undergo home treatment from those who need admission into intensive care units. Methods To validate the prognostic model for early mortality after PE diagnosis proposed by the European Society of Cardiology (ESC) in 2014, we analyzed data of a cohort of 272 consecutive patients with acute PE, observed in our hospital during a 10-year period. Moreover, we evaluated the additional contribution of D-dimer, measured at PE diagnosis, in improving the prognostic ability of the model. All cases of PE were objectively diagnosed by angiography chest CT scan or perfusion lung scan. Results The overall mortality rate within 30 days from PE diagnosis was 10% (95% confidence interval [CI]: 6.4–13.5%). According to the ESC prognostic model, the risk of death increased 3.23 times in the intermediate-low-risk category, 5.55 times in the intermediate-high-risk category, and 23.78 times in the high-risk category, as compared with the low-risk category. The receiver operating characteristic analysis showed a good discriminatory power of the model (area under the curve [AUC] = 0.77 [95% CI: 0.67–0.87]), which further increased when D-dimer was added (AUC = 0.85 [95% CI: 0.73–0.96]). Conclusion This study represents a good validation of the ESC predictive model whose performance can be further improved by adding D-dimer plasma levels measured at PE diagnosis.

scholarly journals 2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC)

2013 ◽  
Vol 31 (10) ◽  
pp. 1925-1938 ◽  
Author(s):  
Giuseppe Mancia ◽  
Robert Fagard ◽  
Krzysztof Narkiewicz ◽  
Josep Redán ◽  
Alberto Zanchetti ◽  
...  
Keyword(s):  
Arterial Hypertension ◽  
Practice Guidelines ◽  
European Society ◽  
European Society Of Cardiology
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