Effect of Prognostic Guided Management of Patients With Acute Pulmonary Embolism According to the European Society of Cardiology Risk Stratification Model.

Autor:	Jiménez D; Respiratory Department, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain.; Department of Medicine, Universidad de Alcalá, Madrid, Spain.; CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain., Rodríguez C; Respiratory Department, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain., Pintado B; Respiratory Department, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain., Pérez A; Respiratory Department, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain., Jara-Palomares L; Respiratory Department, Virgen del Rocío Hospital, Instituto de Biomedicina, Seville, Spain., López-Reyes R; Respiratory Department, Hospital La Fe, Valencia, Spain., Ruiz-Artacho P; CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.; Department of Internal Medicine, Clínica Universidad de Navarra, Madrid, Spain.; Interdisciplinar Teragnosis and Radiosomics Research Group (INTRA-Madrid), Universidad de Navarra, Madrid, Spain., García-Ortega A; Respiratory Department, Hospital La Fe, Valencia, Spain., Bikdeli B; Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.; Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, United States.; Cardiovascular Research Foundation, New York, NY, United States., Lobo JL; CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.; Respiratory Department, Hospital Araba, Vitoria-Gasteiz, Spain.
Jazyk:	angličtina
Zdroj:	Frontiers in cardiovascular medicine [Front Cardiovasc Med] 2022 Apr 12; Vol. 9, pp. 872115. Date of Electronic Publication: 2022 Apr 12 (Print Publication: 2022).
DOI:	10.3389/fcvm.2022.872115
Abstrakt:	Background: A recent trial showed that management driven by prognostic assessment was effective in reducing the length of stay (LOS) for acute stable pulmonary embolism (PE). The efficacy and safety of this strategy in each subgroup of risk stratification remains unknown. Methods: We conducted a post-hoc analysis of the randomized IPEP study to evaluate the effect of a management strategy guided by early use of a prognostic pathway in the low- and intermediate-high risk subgroups defined by the European Society of Cardiology (ESC) model. These subgroups were retrospectively identified in the control arm. The primary outcome was LOS. The secondary outcomes were 30-day clinical outcomes. Results: Of 249 patients assigned to the intervention group, 60 (24%) were classified as low-, and 30 (12%) as intermediate-high risk. Among 249 patients assigned to the control group, 66 (27%) were low-, and 13 (5%) intermediate-high risk. In the low-risk group, the mean LOS was 2.1 (±0.9) days in the intervention group and 5.3 (±2.9) days in the control group ( P < 0.001). In this group, no significant differences were observed in 30-day readmissions (0% vs. 3.0%, respectively), all-cause (0% vs. 0%) and PE-related mortality rates (0% vs. 0%), or severe adverse events (0% vs. 1.5%). In the intermediate-high risk group, the mean LOS was 5.3 (±1.8) days in the intervention group and 6.5 (±2.5) days in the control group ( P = 0.08). In this group, no significant differences were observed in 30-day readmissions (3.3% vs. 3.0%, respectively), all-cause (6.7% vs. 7.7%) and PE-related mortality rates (6.7% vs. 7.7%), or severe adverse events (16.7% vs. 15.4%). Conclusion: The use of a prognostic assessment and management pathway was effective in reducing the LOS for acute PE without comprising safety across subgroups of risk stratification. Clinical Trial Registration: [ClinicalTrials.gov], Identifier [NCT02733198]. Competing Interests: DJ has served as an advisor or consultant for Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Leo Pharma, Pfizer, ROVI, and Sanofi; served as a speaker or a member of a speakers’ bureau for Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Leo Pharma, ROVI, and Sanofi; received grants for clinical research from Daiichi Sankyo, Sanofi, and ROVI. LJ-P has served as an advisor or consultant for Actelion Pharmaceuticals, Bayer HealthCare Pharmaceuticals, Leo Pharma, Menarini, Pfizer, and ROVI. PR-A has served as an advisor or consultant for Leo Pharma and Viatris; served as a speaker or a member of a speakers’ bureau for Bristol-Myers Squibb, Pfizer, Daiichi Sankyo, ROVI, and Viatris; received grants for clinical research from ROVI. BB is a recipient of the IGNITE Award from the Mary Horrigan Connors Center for Women’s Health and Gender Biology at Brigham and Women’s Hospital and reports that he is a consulting expert, on behalf of the plaintiff, for litigation related to two specific brand models of IVC filters. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2022 Jiménez, Rodríguez, Pintado, Pérez, Jara-Palomares, López-Reyes, Ruiz-Artacho, García-Ortega, Bikdeli, Lobo and the IPEP investigators.)
Databáze:	MEDLINE
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