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TIMI Risk Index as a Predictor of 30-Day Outcomes in Patients With Acute Pulmonary Embolism

By Marco Zuin, Luca Conte, Claudio Picariello, Gianni Pastore, Dobrin Vassiliev, Daniela Lanza, Pietro Zonzin, Giovanni Zuliani, Gianluca Rigatelli and Loris Roncon


Background Available studies have already identified age, heart rate (HR) and systolic blood pressure (SBP) as strong predictors of early mortality in acute pulmonary embolism (PE). Material and Methods One-hundred-seventy patients, with acute PE confirmed on computed tomography angiography (CTA) were enrolled. Thrombolysis In Myocardial Infarction (TIMI) risk index (TRI) was calculated using the formula [heart rate (HR) x (AGE/102)/ systolic blood pressure (SBP)]. Study outcomes were 30-day mortality and/or clinical deterioration. Results Receiver operating characteristics (ROC) curve revealed that a TRI â\u89¥45 was highly specific for both outcomes (AUC 0.91, 95% CI 0.83â\u80\u930.98, p < 0.0001) with a positive predictive value (PPV) and negative predictive value (NPV) of 8.3 and 96% for 30-day mortality while PPV and NPV for 30-day mortality and/or clinical deterioration were 21.1 and 98.2%, respectively. Multivariate regression analysis showed that TRI â\u89¥45 was an independent predictor of 30-day mortality (O.R. 22.24, 95% CI 2.54â\u80\u93194.10, p = 0.005) independently from positive cTnI and RVD (O.R. 9.57, 95% CI 1.88â\u80\u9348.78, p = 0.007; OR 24.99, 95% CI 2.84â\u80\u93219.48, p = 0.004). Similarly, 30-day mortality and/or clinical deterioration was predicted by TRI â\u89¥45 (O.R. 11.57, 95% CI 2.36â\u80\u9356.63, p = 0.003) and thrombolysis (3.83, 95% CI 1.04â\u80\u9314.09, p = 0.043), independently from age, RVD and positive cTnI. Cox regression analysis confirmed the role of TRI as independent predictor for both outcomes. Mantel-Cox analysis showed that after 30-day follow-up there was a statistically significant difference in the distribution of survival between patients with and without TRI â\u89¥45 [log rank (Mantel-Cox) chi-square 17.04, p < 0.0001]. Conclusions Thrombolysis In Myocardial Infarction (TIMI) risk index (TRI) predicted both 30-days mortality (all-causes) and/or clinical deterioration in patients with acute PE

Topics: Pulmonary embolism, Risk stratification, TIMI risk index, Pulmonary and Respiratory Medicine, Cardiology and Cardiovascular Medicine
Year: 2018
DOI identifier: 10.1016/j.hlc.2017.02.035
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