Usefulness of the Pesi Score to Predict the Need for Escalation Therapy Among Intermediate Risk Pulmonary Emboli Patients

Sharon Shalom Natanzon Cardiology, Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel Shlomi Matetzky Cardiology, Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel Orly Goitein Diagnostic Imaging, Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel Lichay Kaufman Cardiology, Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel Nir Shlomo Cardiology, Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel Fernando Chernomordik Cardiology, Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel Israel Mazin Cardiology, Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel Sagit Ben-Zekery Cardiology, Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel Yigal Kassif Department of Cardiac Surgery, Department of Cardiac Surgery, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel Avishay Grupper Cardiology, Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel Roy Beigel Cardiology, Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel

Background: The Pesi/sPesi are well validated clinical scores for the risk stratification of pulmonary embolism (PE) patients. While studies have found these scores to be a useful tool predicting both short and long-term mortality for higher risk patients, their ability to predict the need for escalation therapy among intermediate risk PE patients has not been evaluated.

Methods: We evaluates 203 consecutive intermediate risk PE patients admitted to the Sheba Medical Center ICCU. Patients were stratified to Low (Pesi<2, sPesi-0) and high (Pesi≥3, sPesi-1) Pesi/sPesi score. Escalation therapy was defined as one or several of the following: the need for reperfusion therapy (both surgical and thrombolysis), ionotropic agents, mechanical ventilation, and in-hospital as well as 90 days mortality.

Results: PE patients with higher Pesi/sPesi scores were older (72.4ֲ±11.1 vs 57.4ֲ±17.4, p<0.001), and had a higher incidence of malignancy (32% vs 3%, p<0.001). There was no significant difference in Troponin and D dimer levels (0.69ֲ±1.5ng/ml vs 1.15ֲ±2.16ng/ml, p=0.08, 3947ֲ±7678ng/ml vs 4638ֲ±7900ng/ml, p=0.56 respectively). No significant difference in the incidence of RV dilation on CTA (56.2% vs 57.8%, p=0.933) and moderate or severe RV dysfunction on echocardiography (44.6% vs 43.4%, p=0.983). There was a trend toward a higher need for escalation therapy in the high Pesi/sPesi group (7.6% vs 16.5%, p=0.091).

Conclusion: In PE patients at intermediate risk, patients with a higher Pesi/sPesi score demonstrated a trend towards a higher need for escalation therapy. Larger studies may provide further insight to the usefulness of the PESI score for prediction of the need for escalation therapy.

Presentation