Prognostic Impact of Thrombolysis in Myocardial Infarction Risk Index on Hospitalization Mortality of Patient with Acute Pulmonary Embolism

Document Type: Original Article

Authors

Cardiologist, Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

10.22038/jctm.2020.49497.1277

Abstract

Introduction: Acute pulmonary embolism (PE) is one of the deadly cardiovascular diseases. One of the indexes proposed in these patients for risk stratification is the Thrombolysis in Myocardial Infarction (TIMI) risk index (TRI), which includes three parameters of systolic blood pressure, age, and heart rate. This study aimed to evaluate the predictive value of TRI on in-hospital and 30-day mortality of PE patients.
Materials and Methods: This cross-sectional study included 345 patients who were diagnosed with acute PE in Madani Heart Center from January 2012 to January 2017. Demographic characteristics, hemodynamic findings upon first admission, type of treatment (i.e., thrombolytic, anticoagulant, or surgery), as well as in-hospital and 30-day outcomes were recorded for all patients. The TRI and simplified Pulmonary Embolism Severity Index (PESI) were calculated for all patients.
Results: The overall and in-hospital mortality rates were 8.7% and 8.1%, respectively. The mortality group were significantly older and had significantly higher heart rates, cardiac troponin levels, simplified PESI scores, and TRI followed by lower systolic blood pressure and O2 saturation. Moreover, the TRI obtained specificity, sensitivity, positive, and negative predictive values of 98.78%, 25.25%, 89.29%, and 76.66%, respectively, using receiver operating characteristic curves and a cut-off value of 36.73. Using the multiple logistic regression analysis we found that TRI>36.73, older age, higher heart rate and lower SBP could predict 30-day mortality.  
Conclusion: Theresults showed that the risk of in-hospital mortality is higher with an increase in TRI. Furthermore, despite the high specificity, lower sensitivity limits its utility.

Keywords


1. Lee Chuy K, Hakemi EU, Alyousef T, Dang G, Doukky R. The long-term prognostic value of highly sensitive cardiac troponin I in patients with acute pulmonary embolism. Clin Cardiol. 2017; 40:1271-8.

2. Kilic T, Ermis H, Gülbas G, Kaya O, Aytemur ZA, Inceoglu F, et al. Prognostic role of the simplified pulmonary embolism severity index and shock index in pulmonary embolism. Pol Arch Med Wewn. 2014; 124:678-87.

3. Vamsidhar A, Rajasekhar D, Vanajakshamma V, Lakshmi AY, Latheef K, Siva Sankara C, et al. Comparison of PESI, echocardiogram, CTPA, and NT-proBNP as risk stratification tools in patients with acute pulmonary embolism. Indian Heart J. 2017; 69:68-74.

4. Soriano LA, Castro TT, Vilalva K, Borges MC, Pazin-Filho A, Miranda CH. Validation of the Pulmonary Embolism Severity Index for risk stratification after acute pulmonary embolism in a cohort of patients in Brazil. J Bras Pneumol. 2019; 45:e20170251.

5. Keller K, Beule J, Coldewey M, Dippold W, Balzer JO. Heart rate in pulmonary embolism. Intern Emerg Med. 2015; 10:663-96.

6. Keller K, Beule J, Coldewey M, Geyer M, Balzer JO, Dippold W. The risk factor age in normotensive patients with pulmonary embolism: effectiveness of age in predicting submassive pulmonary embolism, cardiac injury, right ventricular dysfunction and elevated systolic pulmonary artery pressure in normotensive pulmonary embolism patients. Exp Gerontol. 2015; 69:116-21.

7. Keller K, Beule J, Balzer JO, Dippold W. Blood pressure for outcome prediction and risk stratification in acute pulmonary  Embolism. Am J Emerg Med. 2015; 33:1617-21.

8. Keskin M, Güvenç TS, Hayıroğlu Mİ, Kaya A, Tatlısu MA, Avşar Ş, et al. A novel prognostic indicator for in-hospital and 4-year outcomes in patients with pulmonary embolism: TIMI risk index. J Crit Care 2017; 41:183-90.

9. Zuin M, Conte L, Picariello C, Pastore G, Vassiliev D, Lanza D, et al. TIMI risk index as a predictor of 30-day outcomes in patients with acute pulmonary embolism. Heart Lung Circ. 2018; 27:190-8.

10. Keller K, Beule J, Coldewey M, Dippold W, Balzer JO. Impact of advanced age on the severity of normotensive pulmonary embolism. Heart Vessels. 2015; 30:647-56.

11. Keller K, Beule J, Balzer JO, Dippold W. Modified Bova score for risk stratification and short-term outcome in acute pulmonary embolism. Neth J Med. 2015; 73:410-6.

12. El-Menyar A, Asim M, Nabir S, Ahmed MN, Al-Thani H. Implications of elevated cardiac troponin in patients presenting with Acute pulmonary embolism: an observational study. J Thorac Dis. 2019; 11:3302-14.

13. Hayıroğlu Mİ, Keskin M, Keskin T, Uzun AO, Altay S, Kaya A, et al. A novel independent survival predictor in pulmonary embolism: prognostic nutritional index. Clin Appl Thromb Hemost. 2018; 24:633-9.

14. Dentali F, Riva N, Turato S, Grazioli S, Squizzato A, Steidl L, et al. Pulmonary embolism severity index accurately predicts long-term mortality rate in patients hospitalized for acute pulmonary embolism. J Thromb Haemost. 2013; 11:2103-10.

15. Acet H, Ertaş F, Bilik MZ, Aydın M, Yüksel M, Polat N, et al. The relationship of TIMI risk index with SYNTAX and Gensini risk scores in predicting the extent and severity of coronary artery disease in patients with STEMI undergoing primary percutaneous coronary intervention. Ther Adv Cardiovasc Dis. 2015; 9:257-66.

16. Zhou XY, Ben SQ, Chen HL, Ni SS. The prognostic value of pulmonary embolismseverity index in acute pulmonary embolism: a meta-analysis. Respir Res. 2012; 13:111.