Effectiveness of prognosticating pulmonary embolism using the ESC algorithm and the Bova score

Area of Science:

• Cardiology
• Pulmonary Medicine
• Clinical Risk Stratification

Background:

• The prognostic value of the European Society of Cardiology (ESC) 2014 algorithm and the Bova score for pulmonary embolism (PE) requires further validation.
• Accurate risk stratification is crucial for managing normotensive PE patients and optimizing treatment strategies.

Purpose of the Study:

• To retrospectively evaluate the prognostic accuracy of the ESC 2014 algorithm and the Bova score in normotensive patients with PE.
• To assess the added value of computed tomographic pulmonary angiography (CTPA) for right ventricle (RV) dysfunction in identifying low-risk PE patients.

Main Methods:

• Retrospective analysis of normotensive PE patients from the PROTECT study.
• Risk stratification using the ESC 2014 algorithm (sPESI) and Bova score.
• Primary endpoint: complicated course (death, haemodynamic collapse, recurrent PE) within 30 days.
• Inclusion of CTPA for RV dysfunction and troponin levels in risk assessment.

Main Results:

• Of 848 patients, 37% had a simplified pulmonary embolism severity index (sPESI) of 0, with a 1.6% complicated course rate.
• CTPA for RV dysfunction in sPESI 0 patients did not significantly alter the low-risk identification (2.1% complicated course).
• Patients with sPESI ≥ 1 and RV dysfunction or elevated troponin had a 10% complicated course rate, while those with both had a 17.5% rate.
• Bova risk class III showed a 21.6% complicated course rate.

Conclusions:

• The ESC 2014 prognostic algorithm demonstrates effectiveness in risk stratifying normotensive PE patients.
• CTPA does not improve the identification of low-risk PE.
• Bova risk scoring provides limited additional benefit in identifying intermediate-high risk PE.