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Prognostic Value of the Composite Pulmonary Embolism Shock Score in Acute Intermediate-Risk Pulmonary Embolism
Session:
SESSÃO DE POSTERS 13 - CONGÉNITOS E HTP 1
Speaker:
Inês Amorim Cruz
Congress:
CPC 2025
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.2 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Cartazes
FP Number:
---
Authors:
Inês Amorim Cruz; Tiago Aguiar; Simão Carvalho; Carlos Costa; Joana Ribeiro; Luís Miguel Santos; Ana Briosa
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><em><u><span style="font-size:11pt">Background:</span></u></em><span style="font-size:10.5pt"> One of the critical pillars for managing acute pulmonary embolism (PE) is adequate risk stratification, as it may influence decisions for treatment escalation. Although intermediate-risk PE patients may appear stable, they represent a heterogeneous group with high in-hospital mortality. In FLASH Registry, in patients submmited to mechanical thrombectomy, over one-third were in normotensive shock with a low cardiac index and the Composite Pulmonary Embolism Shock (CPES) score has been developed to identify these patients. However, few is known if CPES score predicts adverse clinical outcomes.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><em><u><span style="font-size:11pt">Aim:</span></u></em><span style="font-size:10.5pt"> To explore if the CPES score predicts adverse outcomes in patients with acute intermediate-risk PE.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><em><u><span style="font-size:11pt">Methods:</span></u></em><span style="font-size:10.5pt"> All consecutive patients with acute intermediate-risk PE admitted between January 2016 and December 2020 were included. For CPES score, 1 point was attributed for each marker: elevated troponin, elevated B-type natriuretic peptide, concomitant deep vein thrombosis, saddle PE, moderately or severely reduced RV function, and tachycardia. The primary outcome was a composite of in-hospital mortality, resuscitated cardiac arrest, or hemodynamic decompensation. A time-to-event analysis was carried, including Kaplan-Meier analysis and Cox proportional hazard models. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><em><u><span style="font-size:11pt">Results:</span></u></em><em> </em><span style="font-size:10.5pt">Among the 151 patients with intermediate-risk PE (63% women, median age 77 years [IQR 69–85], and 13% with a history of venous thromboembolism), 31% were classified as intermediate-high risk PE, and 19 (13%) experienced a primary outcome event. Patients with a CPES score > 3 were younger, more frequently obese, and more likely to have undergone systemic thrombolysis. In univariable Cox regression analysis, a higher CPES score was not significantly associated with a worse primary composite outcome (Hazard Ratio = 1.22, [95% CI, 0.85–1.76], p = 0.3). Inspecting Kaplan-Meier curve, while patients with a CPES score > 3 had not a higher risk of adverse outcomes compared to patients CPES score ≤ 3 (Figure 1, log-rank test p=0.17), a trend toward curve separation was observed, suggesting that the sample size may be insufficient to demonstrate a definitive effect.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><em><u><span style="font-size:11pt">Conclusion:</span></u></em><span style="font-size:10.5pt"> In this cohort of patients with acute intermediate-risk PE, the CPES score did not effectively predict adverse clinical outcomes. However, a trend toward curve separation was observed, indicating that the sample size may have been insufficient and futher studies are needed.</span></span></span></span></p>
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