Utility of simplified PESI score for mid-term mortality risk stratification: Insights from the combined COMMAND-VTE...

The simplified Pulmonary Embolism Severity Index (sPESI) is widely used to predict short-term mortality in acute pulmonary embolism (PE), but its value for 2-3-year mortality risk stratification remains unclear. We evaluated whether sPESI predicts 2.6-year all-cause mortality in a nationwide Japanese venous thromboembolism (VTE) cohort.

Post-hoc analysis of the combined COMMAND-VTE Registry 1 and 2 (n = 8224). Patients were classified as deep vein thrombosis (DVT) alone (n = 3722) or PE with sPESI categories of 0, 1, 2, 3, or 4-6 at presentation (n = 4502). All-cause death was assessed using Kaplan-Meier and univariate Cox models, including a 30-day landmark analysis (day 31 onward). These registries span the warfarin and direct oral anticoagulant eras in Japan. Scores 4-6 were combined to ensure stable estimates, consistent with prior analyses from the same registry.

Median follow-up was 878 days. Among PE patients, 22.3% had sPESI = 0, 34.2% sPESI = 1, 24.7% sPESI = 2, 14.4% sPESI = 3, and 4.5% sPESI = 4-6. Each 1-point increase in sPESI was associated with higher mortality (hazard ratio 1.75; 95% confidence interval 1.67-1.84). Survival separated stepwise and persisted beyond 30 days (overall log-rank p < 0.001). DVT alone showed survival comparable to PE with sPESI = 1 in exploratory comparisons.

sPESI provided clear mid-term risk stratification for mortality among PE patients in contemporary Japanese practice and may inform post-discharge risk assessment and follow-up intensity.