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A Porcine Model of Acute Autologous Pulmonary Embolism
Published on: September 6, 2024
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New risk classification adapting SCAI shock stages to patients with pulmonary embolism (RISA-PE).
Rocío Párraga1,2, Carlos Real1,2, Jesús Jiménez-Mazuecos3
1Department of Cardiology, Hospital Universitario Clínico San Carlos, Madrid, Spain.
Minerva Cardiology and Angiology
|September 24, 2024
Summary
A new risk classification for pulmonary embolism (PE), RISA-PE, offers improved patient stratification compared to current guidelines. This system better predicts adverse events in acute PE, aiding clinical decision-making.
Area of Science:
- Cardiology
- Pulmonary Medicine
- Critical Care Medicine
Background:
- Current European Society of Cardiology (ESC) guidelines stratify pulmonary embolism (PE) risk, but emerging therapies necessitate more refined classification.
- Existing methods may not adequately capture the nuanced risk profiles of patients undergoing advanced interventions.
Purpose of the Study:
- To introduce and evaluate a novel risk classification system, RIsk claSsification Adapting the SCAI shock stages to right ventricular failure due to acute PE (RISA-PE).
- To assess the RISA-PE system's performance in stratifying risk and predicting in-hospital adverse events in intermediate-high and high-risk PE patients.
Main Methods:
- A registry study included 334 intermediate-high risk (IHR) or high-risk (HR) acute PE patients undergoing catheter-directed interventions (CDI) across 15 Spanish centers (2018-2023).
- Patients were classified into RISA-PE stages A-E based on right ventricular dysfunction, troponin elevation, lactate levels, shock index, hypotension, obstructive shock, and cardiac arrest.
- In-hospital adverse events, including all-cause death, major bleeding, and acute kidney injury, were analyzed to evaluate RISA-PE's predictive performance.
Main Results:
- In-hospital all-cause mortality significantly increased with each RISA-PE stage (1.2% to 57.7%, P<0.001), demonstrating progressive risk stratification.
- The RISA-PE classification showed a more granular risk assessment compared to the ESC classification, which revealed an abrupt mortality difference between IHR and HR PE patients (4.3% vs. 29.3%, P<0.001).
- Incidence of major bleeding and acute kidney injury also followed a similar pattern of increased risk across RISA-PE stages.
Conclusions:
- The RISA-PE classification provides a user-friendly and granular approach to stratifying risk in acute PE patients.
- This novel system shows potential for improved clinical decision-making, particularly for patients undergoing advanced interventions.
- Further validation in larger, diverse populations and with different therapeutic strategies is warranted to confirm its utility.
