Acute pulmonary embolism: a multimarker calculator to predict short-term outcomes

Area of Science:

• Cardiology
• Pulmonary Medicine
• Medical Informatics

Background:

• Accurate risk stratification is crucial for managing acute pulmonary embolism (PE).
• Current models, like the European Society of Cardiology (ESC) model, require validation and improvement.
• Identifying high-risk PE patients enables timely, targeted interventions.

Purpose of the Study:

• To validate a novel multimarker prognostic calculator for acute PE.
• To compare the performance of the multimarker calculator against the ESC model.
• To assess the calculator's ability to predict 30-day all-cause mortality in stable PE patients.

Main Methods:

• Utilized data from 60,042 stable acute PE patients from the Registro Informatizado de la Enfermedad TromboEmbólica registry.
• The multimarker calculator incorporates simplified Pulmonary Embolism Severity Index variables, natriuretic peptide, troponin, and deep vein thrombosis status.
• Compared discrimination and calibration of the multimarker calculator versus the ESC model, with 30-day all-cause mortality as the primary outcome.

Main Results:

• The multimarker calculator demonstrated significantly improved C-statistics compared to the ESC model (0.79 vs. 0.56, P < .001).
• Performance remained superior even with available data for right ventricular function/size and troponin (0.78 vs. 0.66, P < .001).
• At a >10% risk threshold, the multimarker calculator had a higher positive predictive value for mortality (15.7% vs. 5.0%, P < .001).

Conclusions:

• The multimarker calculator offers substantially improved risk stratification for mortality in stable acute PE patients.
• This tool surpasses the predictive performance of the current ESC model.
• Enhanced risk stratification can lead to more precise patient management and improved outcomes.