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Dönmez E, Özcan S, Sahin İ, Ziyrek M, Okuyan E. Can GRACE Risk Score Predict Mortality and the Need for Thrombolytic Treatment in Acute Pulmonary Embolism? Am J Cardiol 2024; 211:115-121. [PMID: 37923156 DOI: 10.1016/j.amjcard.2023.10.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/29/2023] [Accepted: 10/28/2023] [Indexed: 11/07/2023]
Abstract
Acute coronary syndrome and pulmonary embolism (PE) are clinical entities sharing similar presentation and risk factors. Risk scores and indexes help to identify disease severity in both diseases. In this study, we aimed to evaluate if the Global Registry of Acute Coronary Events (GRACE) risk score could predict 30-day mortality and the need for thrombolytic treatment in patients with acute PE. Patients hospitalized with a diagnosis of PE in our tertiary center between January 2018 and May 2022 were included in this retrospective study. Pulmonary Embolism Severity Index (PESI) and GRACE risk scores on admission were calculated using clinical, electrocardiographic, and laboratory parameters for each patient. A total of 197 patients were included. The 30-day mortality rate was 28.4% whereas 32.5% of the patients required thrombolytic treatment. GRACE and PESI scores were found independent risk factors associated with 30-day mortality and the need for thrombolytic treatment. A cut-off value of 160.5 for GRACE score was associated with 88.5% sensitivity and 89.4% specificity in prediction of 30-day mortality. In contrast, GRACE score had 61.0% sensitivity and 60.0% specificity in the prediction of the need for thrombolytic treatment when the cut-off value was 147. In conclusion, GRACE risk score has an effective discriminating power in determining the early mortality of patients with acute PE. The incidence of short-term PE-related mortality was significantly increased in patients with high GRACE risk scores. Concomitant use of GRACE and PESI risk scores may aid in defining patients with high-risk PE and help predict poor prognosis with high specificity and probability.
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Affiliation(s)
- Esra Dönmez
- Department of Cardiology, Bağcılar Training and Research Hospital, Bağcılar, İstanbul, Turkey
| | - Sevgi Özcan
- Department of Cardiology, Bağcılar Training and Research Hospital, Bağcılar, İstanbul, Turkey.
| | - İrfan Sahin
- Department of Cardiology, Bağcılar Training and Research Hospital, Bağcılar, İstanbul, Turkey
| | - Murat Ziyrek
- Department of Cardiology, Bağcılar Training and Research Hospital, Bağcılar, İstanbul, Turkey
| | - Ertugrul Okuyan
- Department of Cardiology, Bağcılar Training and Research Hospital, Bağcılar, İstanbul, Turkey
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Bashir DA, Cargill JC, Gowda S, Musick M, Coleman R, Chartan CA, Hensch L, Pezeshkmehr A, Qureshi AM, Sartain SE. Implementing a Pediatric Pulmonary Embolism Response Team Model: An Institutional Experience. Chest 2024; 165:192-201. [PMID: 38199732 DOI: 10.1016/j.chest.2023.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 01/12/2024] Open
Abstract
Pulmonary embolism is increasing in prevalence among pediatric patients; although still rare, it can create a significant risk for morbidity and death within the pediatric patient population. Pulmonary embolism presents in various ways depending on the patient, the size of the embolism, and the comorbidities. Treatment decisions are often driven by the severity of the presentation and hemodynamic effects; severe presentations require more invasive and aggressive treatment. We describe the development and implementation of a pediatric pulmonary embolism response team designed to facilitate rapid, multidisciplinary, data-driven treatment decisions and management.
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Affiliation(s)
- Dalia A Bashir
- Department of Pediatrics, Division of Critical Care Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, TX.
| | - Jamie C Cargill
- Department of Pediatrics, Division of Critical Care Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Srinath Gowda
- Division of Cardiology- Interventional Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Matthew Musick
- Department of Pediatrics, Division of Critical Care Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Ryan Coleman
- Department of Pediatrics, Division of Critical Care Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Corey A Chartan
- Department of Pediatrics, Division of Critical Care Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Lisa Hensch
- Department of Pathology & Immunology and Anesthesia, Division of Transfusion Medicine & Coagulation, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Amir Pezeshkmehr
- Department of Radiology, Division of Interventional Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Athar M Qureshi
- Division of Cardiology- Interventional Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Sarah E Sartain
- Division of Hematology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
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Pulmonary Embolism in the Cancer Associated Thrombosis Landscape. J Clin Med 2022; 11:jcm11195650. [PMID: 36233519 PMCID: PMC9570910 DOI: 10.3390/jcm11195650] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/11/2022] [Accepted: 09/19/2022] [Indexed: 11/17/2022] Open
Abstract
In cancer patients, pulmonary embolism (PE) is the second leading cause of death after the cancer itself, most likely because of difficulties in diagnosing the disease due to its nonclassical presentation. The risk of PE recurrence and possibly the case-fatality rate depends on whether the patient presents a symptomatic PE, an unsuspected PE, a subsegmental PE, or a catheter-related PE. Choosing the best therapeutic option is challenging and should consider the risk of both the recurrence of thrombosis and the occurrence of bleeding. The purpose of this review is to provide an overview of the clinical characteristics and the treatment of cancer-associated PE, which could benefit clinicians to better manage the deadliest form of thrombosis associated with cancer. After a brief presentation of the epidemiological data, we will present the current attitude towards the diagnosis and the management of cancer patients with PE. Finally, we will discuss the perspectives of how the medical community can improve the management of this severe medical condition.
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