Utility of simplified PESI score for identification of low-risk pulmonary embolism patients with active cancer: From the COMMAND VTE Registry

Yugo Yamashita, Takeshi Morimoto, Hidewo Amano, Toru Takase, Seiichi Hiramori, Kitae Kim, Maki Oi, Masaharu Akao, Yohei Kobayashi, Mamoru Toyofuku, Toshiaki Izumi, Tomohisa Tada, Po-Min Chen, Koichiro Murata, Yoshiaki Tsuyuki, Yuji Nishimoto, Syunsuke Saga, Tomoki Sasa, Jiro Sakamoto, Minako Kinoshita, Kiyonori Togi, Hiroshi Mabuchi, Kensuke Takabayashi, Yusuke Yoshikawa, Hiroki Shiomi, Takao Kato, Takeru Makiyama, Koh Ono, Takeshi Kimura
Chest 2019 October 9

BACKGROUND: The simplified pulmonary embolism severity index (sPESI) score is a practical score for identification of low-risk pulmonary embolism (PE) patients, although it has not been applied in active cancer patients. The current study aimed to evaluate the utility of sPESI score for PE patients with active cancer.

METHODS: The COMMAND VTE Registry is a multicenter registry enrolling consecutive patients with acute symptomatic venous thromboembolism (VTE). The current study population consisted of 368 PE patients with active cancer. The 30-day clinical outcomes were compared between the patients with sPESI score=1 and patients with sPESI score ≥2.

RESULTS: Overall, 37 (10%) patients died during 30 days after diagnosis. The cumulative 30-day incidences of mortality, and PE-related death were lower in the patients with sPESI score=1 than in the patients with sPESI score ≥2 (6.3% versus 13.1%, log rank P=0.03, and 0.7% versus 3.9%, log rank P=0.046). Among patients with sPESI score=1, the predominant cause of deaths was cancer. There were no significant differences in the cumulative 30-day incidence of recurrent VTE and major bleeding between the 2 groups (3.9% versus 5.6%, log rank P=0.46, and 6.4% versus 4.5%, log rank P=0.45).

CONCLUSIONS: Among PE patients with active cancer, patients with sPESI score=1 had a lower 30-day mortality rate compared with patients with sPESI score ≥2, and they showed a very low PE-related mortality risk, although overall mortality rate remained high due to cancer-related mortality. They also showed relatively high risks for recurrence and major bleeding, suggesting the need for careful follow-up.


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