The Composite PE Shock score (CPES) demonstrated higher discriminatory power for predicting adverse hemodynamic outcomes in acute pulmonary embolism compared to sPESI (AUC 0.76 vs 0.65).
Cohort (n=125)
No
Do hsTropT cutoffs and CPES improve prediction of early hemodynamic deterioration compared to sPESI in patients with acute pulmonary embolism?
CPES and a hsTropT cutoff ≥ 120 ng/L outperformed sPESI in predicting early hemodynamic deterioration and escalation of care in patients with acute pulmonary embolism.
Effect estimate: AUC 0.76 (CPES) vs 0.65 (sPESI)
Abstract Introduction The European Society of Cardiology (ESC) recommends utilizing high-sensitivity troponin T (hsTropT) and Simplified Pulmonary Embolism Severity Index (sPESI) to risk stratify acute pulmonary embolism (PE) for 30-day mortality. However, these tools exhibit poor positive predictive value for predicting hemodynamic compromise, a common phenotype in patients in intermediate-risk PE. Recently, the Composite PE Shock score (CPES) was developed to prognosticate negative hemodynamic outcomes, but has not yet been extensively appraised against established risk stratification tools. The primary objective of this study was to determine optimal hsTrop-T cutoffs to identify PE phenotypes at high risk for early hemodynamic deterioration. The secondary objective was to compare the performance of CPES and sPESI for predicting adverse hemodynamic outcomes in acute PE. Methods A retrospective analysis was conducted on 125 patients who triggered PERT activation in our institution between 2023-2025 with available hsTrop-T and N-terminal pro-brain natriuretic peptide (NT-proBNP) obtained within 6 hours of diagnosis. CPES and sPESI were calculated for the cohort. The primary composite outcome included right ventricular (RV) strain seen on computed tomography pulmonary angiography (CTPE) or transthoracic echocardiogram (TTE), vasopressor use, ICU admission, and catheter-directed advanced intervention. Receiver operating characteristic (ROC) curves were used to determine optimal hsTrop-T cutoffs and compare the prognostic performance of CPES and sPESI using the composite outcome. Results Our cohort was classified by ESC categorization into low (17.6%), intermediate-low (30%), intermediate-high (49%), and high (3.20%) risk. A total of 28 patients (22%) experienced the primary composite outcome. Mean hsTrop-T was 94.8 ng/L (SD 198.5). The optimal hsTrop-T cutoff ≥ 120 ng/L had high specificity (90%) and moderate sensitivity (54%) for the composite outcome. A lower hsTrop-T cutoff 7 ng/L exhibited high sensitivity (90%) but poor specificity (38%). CPES ≥4 identified 82% of patients with the composite outcome (sensitivity 82%, specificity 68%), while sPESI ≥2 identified 61% (sensitivity 61%, specificity 54%). Overall, CPES demonstrated a higher discriminatory power (AUC 0.76) for predicting the primary composite outcome and its individual components compared to sPESI (AUC 0.65). Conclusions A hsTropT cutoff ≥ 120 ng/L identified patients at high risk for hemodynamic compromise while a lower hsTropT cutoff 7 ng/L identified low-risk patients even in the absence of additional risk stratification tools. Consistent with recent literature, CPES outperformed sPESI for predicting adverse hemodynamic events. sPESI remains useful for mortality prediction and initial triage, but CPES provides greater accuracy for composite outcomes involving escalation of care. This abstract is funded by: None
Venkatakrishna et al. (Fri,) conducted a cohort in acute pulmonary embolism (PE) (n=125). Composite PE Shock score (CPES) and hsTrop-T vs. Simplified Pulmonary Embolism Severity Index (sPESI) was evaluated on Composite of right ventricular strain on CTPE or TTE, vasopressor use, ICU admission, and catheter-directed advanced intervention (AUC 0.76 (CPES) vs 0.65 (sPESI)). The Composite PE Shock score (CPES) demonstrated higher discriminatory power for predicting adverse hemodynamic outcomes in acute pulmonary embolism compared to sPESI (AUC 0.76 vs 0.65).