Choosing the Right Tool: Comparing Risk Stratification Models in Intermediate-Risk Pulmonary Embolism

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.