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Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
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Choosing the Right Tool: Comparing Risk Stratification Models in Intermediate-Risk Pulmonary Embolism.

Robert S Zhang1, Eugene Yuriditsky2, Peter Zhang3

  • 1Division of Cardiology, Weill Cornell Medicine, New York, New York, USA.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|July 22, 2025
PubMed
Summary

The composite PE shock (CPES) score best predicts adverse outcomes in intermediate-risk pulmonary embolism (PE) patients. CPES demonstrates superior performance over other risk stratification tools, supporting its clinical integration for improved patient care.

Keywords:
composite pulmonary embolism shock scoreintermediate‐riskpulmonary embolism

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Area of Science:

  • Cardiology
  • Pulmonary Medicine
  • Clinical Risk Stratification

Background:

  • Guidelines recommend risk stratification for intermediate-risk pulmonary embolism (PE).
  • Head-to-head comparisons of existing risk stratification tools are lacking.
  • This study addresses the need for comparative performance data.

Purpose of the Study:

  • To compare the predictive performance of four risk stratification scores.
  • To evaluate scores in predicting adverse clinical events in intermediate-risk PE patients.

Main Methods:

  • Retrospective study of 192 intermediate-risk PE patients (Oct 2016 - July 2019).
  • Compared Composite PE Shock (CPES), Bova, simplified PE shock index (sPESI), National Early Warning Score (NEWS), and ESC intermediate-risk subcategories.
  • Used Receiver Operator Characteristic (ROC) curves to assess predictive performance for a composite outcome of PE-related mortality, cardiac arrest, or hemodynamic decompensation.

Main Results:

  • The primary composite outcome occurred in 14.6% of patients.
  • CPES showed the highest discriminatory power (AUC: 0.74; 95% CI: 0.66-0.83) for the composite outcome and its components.
  • ESC intermediate-risk subcategory had the lowest predictive performance (AUC: 0.59; 95% CI: 0.51-0.68).

Conclusions:

  • The CPES score significantly outperformed other evaluated tools in predicting adverse outcomes in intermediate-risk PE.
  • Findings support the clinical integration of CPES for enhanced patient selection and timely interventions.
  • CPES can improve management strategies for PE patients requiring escalated care.