Key result
Multimarker calculator improves 30-day mortality risk stratification in stable acute PE vs the ESC model.
Why the study?
Risk stratification of patients with acute PE is critical to guide targeted interventions, but prognostic models require validation and comparison against the European Society of Cardiology model.
Does a multimarker calculator improve prediction of 30-day mortality compared to the ESC model in stable patients with acute pulmonary embolism?
Observational (n=60,042)
Yes
Does a multimarker calculator improve prediction of 30-day mortality compared to the ESC model in stable patients with acute pulmonary embolism?
Effect estimate: C-statistic 0.79
p-value: p=<.001
A multimarker calculator substantially improves risk stratification for 30-day mortality in stable patients with acute pulmonary embolism compared to the standard ESC model.
Multimarker calculator improves 30-day mortality prediction over ESC model in stable PE; extends stratification but leaves adoption open pending prospective trials.
BACKGROUND AND AIMS: Risk stratification of patients with acute pulmonary embolism (PE) is critical to provide targeted interventions aimed at improving patients' outcomes. The objective of this study was to validate a multimarker prognostic calculator and compare its performance with that of the European Society of Cardiology (ESC) model. METHODS: The multimarker calculator estimates absolute risk of key outcomes for an individual patient based on the individual variables of the simplified Pulmonary Embolism Severity Index, natriuretic peptide levels, troponin levels, and concomitant lower limb deep vein thrombosis. Using data for haemodynamically stable patients with acute PE from the Registro Informatizado de la Enfermedad TromboEmbólica registry, the study compared the performance of the multimarker calculator and the ESC model using measures of discrimination and calibration. The primary outcome was 30-day all-cause mortality. RESULTS: A total of 60 042 stable patients with PE (mean age: 67 years, 51.8% female) were included. Compared with the ESC model, the multimarker calculator provided significant C-statistic improvement in the whole cohort (0.79 vs. 0.56; P < .001), in the group of 16 648 participants with available data for right ventricular function/size and troponin (0.78 vs. 0.66; P < .001), and after imputation of missing data (0.79 vs. 0.66; P < .001). At a calculator estimated risk of >10% to identify intermediate-high risk PE, the positive predictive value for mortality was 15.7% (vs. 5.0% for the ESC model; P < .001). CONCLUSIONS: In stable patients with acute PE, the use of a multimarker calculator substantially improved the risk stratification for mortality beyond that of the ESC model.
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Jiménez et al. (2025) conducted an observational in acute pulmonary embolism (n=60,042). multimarker prognostic calculator vs. European Society of Cardiology (ESC) model was evaluated on 30-day all-cause mortality (C-statistic 0.79, p=<.001). A multimarker calculator significantly improved risk stratification for 30-day mortality in stable acute pulmonary embolism compared with the ESC model (C-statistic 0.79 vs 0.56; P<.001).
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