- Email: [email protected]
Outcomes and incremental prognostic value of renal dysfunction after acute pulmonary embolism
184
Emergency care and intensive cardiac care
Results From November 1, 2013 to February 28, 2018, among 1241 consecutive patients included, 1192 had a follow-up of at least 3 months and, among them, 1037 had PE with (727) or without DVT (310). The median age was 69 (55—80, 25th—75th percentiles). Patients with PE-associated DVT had more severe forms of PE (P < 0.0001). However, no significant difference in all-cause mortality rate [HR 1.36 (CI 95%: 0.69—2.92)], or in the composite criterion of all-cause mortality and recurrence rate [HR 1.56 (CI 95%: 0.83—3.10)] was noted at 3 months of follow-up. Conclusion In REMOTEV, coexisting DVT was associated with a higher severity of PE, with no impact on short-term prognosis (death and VTE recurrence). Disclosure of interest The authors declare that they have no competing interest.
explored the relation between adverse outcomes after acute PE and renal dysfunction classified by estimated glomerular filtration rate (eGFR) using the CKD-EPI equation. In addition, the incremental value of adding eGFRCKD-EPI to the European Society of Cardiology (ESC) score for predicting 30-day mortality. Methods Prospective, observational, multicenter, study including 1664 acute PE admitted from 01/2011 to 12/2017. Patients were categorized in 4 groups according to eGFR: Group 1 (eGFR ≥ 60 ml/min/1.73 m2 , n = 1178), group 2 (45—59 ml/min/1.73 m2 , n = 257); group 3 (30—44 ml/min/1.73 m2 , n = 150) and group 4 (≤ 29 ml/min/1.73m2 , n = 79). Results All-cause and cardiovascular death at 30 days and 6 months was higher in group 3 (P = 0.005 and P = 0.03 respectively) and in group 4 (P < 0.001 and P < 0.001 respectively) versus group 1. Major bleeding at 30 days and 6 months was higher in group 2 (P = 0.003) versus group 1 (P = 0.003 and P = 0.003, respectively). Renal function impairment combined with the ESC prognostic algorithm for the prediction of 30-day mortality improved the discriminatory capacity of the model and enabled reclassification in different risk categories in 27% of the patients (Table 1). Conclusion Renal function impairment increases the rate of adverse events after acute PE. Combined with the ESC early mortality risk score, eGFR improves risk classification. Model fit, discrimination, prognostic performances, and reclassification indices when eGFRCKD-EPI is added to the European Society of Cardiology prognostic algorithm for the prediction of the 30-day all-cause death after an acute pulmonary embolism. Disclosure of interest The authors declare that they have no competing interest.
https://doi.org/10.1016/j.acvdsp.2019.09.407 036
Outcomes and incremental prognostic value of renal dysfunction after acute pulmonary embolism R. Chopard 1 , G. Serzian 1 , F. Ecarnot 1,∗ , S. Humbert 2 , N. Falvo 3 , M. Morel-Aleton 4 , B. Bonnet 5 , G. Napporn 6 , E. Kalbacher 7 , L. Obert 8 , B. Degano 9 , G. Capellier 10 , F. Schiele 1 , Nicolas Meneveau 1 1 Cardiologie, Besanc ¸on 2 Internal Medicine, CHU de Besanc ¸on, Besanc¸on 3 Internal Medicine, CHU de Dijon, Dijon 4 Centre Hospitalier, Pontarlier 5 Centre Hospitalier de Vesoul, Vesoul 6 Cardiologie, Centre Hospitalier Louis Pasteur, Dole 7 Oncologie Médicale 8 Chirurgie orthopédique, traumatologique et plastique 9 Physiologie - Explorations Fonctionnelles 10 Réanimation Médicale, CHU de Besanc ¸on, Besanc¸on, France ∗ Corresponding author. E-mail address: fi[email protected] (F. Ecarnot)
https://doi.org/10.1016/j.acvdsp.2019.09.408 026
Early prescription of direct oral anticoagulants for acute intermediate-high risk pulmonary embolism C. Eveno ∗ , R. Chopard , N. Meneveau , F. Schiele Cardiologie, CHRU Jean-Minjoz, Besanc¸on, France
Background Outcomes in patients with acute pulmonary embolism (PE) and renal function impairment are unknown. We
Table 1 Without eGFR OR (95%CI) ESC Prognostic algorithm eGFR CKD-EPI Measures of fit Bayes information criterion Akaike information criterion C-statistic P (Hosmer-Lemeshow) Integrated discrimination improvement Net Reclassification Improvement Prognostic performances Sensitivity Specificity Positive predictive value Negative predictive value Positive likelihood ratio Negative likelihood ratio Youden index
CKD-EPI
With eGFR CKD-EPI OR (95%CI)
2.59 (1.95—3.43)
2.30 (1.72—3.07) 2.60 (1.62—4.70)
607.30 596.47 0.71* 0.057
599.32 583.06 0.77** 0.43 0.054 (0.052—0.056) 0.93 (0.90—0.95)
62.5 64.2 10.1 97.0 1.96 0.50 0.31
76.2 69.9 16.2 98.1 2.12 0.54 0.39
(51.2—72.3) (49.1—74.4) (8.2—11.3) (96.0—98.0) (1.12—3.41) (0.25—1.81) (0.28—0.34)
(61.5—90.2) (47.6—83.5) (14.2—18.2) (97.2—99.2) (1.54—3.12) (0.20—1.56) (0.36—0.41)
eGFRCKD-EPI : estimated glomerular filtration using the Chronic Kidney Disease-Epidemiology Collaboration equation (CKDEPI ) with a threshold value of 55 ml/min/1.73 m2 . ESC: European Society of Cardiology. * Difference in c-statistic: P = 0.03 ** Difference in c-statistic: P = 0.04.
Emergency care and intensive cardiac care
Results From November 1, 2013 to February 28, 2018, among 1241 consecutive patients included, 1192 had a follow-up of at least 3 months and, among them, 1037 had PE with (727) or without DVT (310). The median age was 69 (55—80, 25th—75th percentiles). Patients with PE-associated DVT had more severe forms of PE (P < 0.0001). However, no significant difference in all-cause mortality rate [HR 1.36 (CI 95%: 0.69—2.92)], or in the composite criterion of all-cause mortality and recurrence rate [HR 1.56 (CI 95%: 0.83—3.10)] was noted at 3 months of follow-up. Conclusion In REMOTEV, coexisting DVT was associated with a higher severity of PE, with no impact on short-term prognosis (death and VTE recurrence). Disclosure of interest The authors declare that they have no competing interest.
explored the relation between adverse outcomes after acute PE and renal dysfunction classified by estimated glomerular filtration rate (eGFR) using the CKD-EPI equation. In addition, the incremental value of adding eGFRCKD-EPI to the European Society of Cardiology (ESC) score for predicting 30-day mortality. Methods Prospective, observational, multicenter, study including 1664 acute PE admitted from 01/2011 to 12/2017. Patients were categorized in 4 groups according to eGFR: Group 1 (eGFR ≥ 60 ml/min/1.73 m2 , n = 1178), group 2 (45—59 ml/min/1.73 m2 , n = 257); group 3 (30—44 ml/min/1.73 m2 , n = 150) and group 4 (≤ 29 ml/min/1.73m2 , n = 79). Results All-cause and cardiovascular death at 30 days and 6 months was higher in group 3 (P = 0.005 and P = 0.03 respectively) and in group 4 (P < 0.001 and P < 0.001 respectively) versus group 1. Major bleeding at 30 days and 6 months was higher in group 2 (P = 0.003) versus group 1 (P = 0.003 and P = 0.003, respectively). Renal function impairment combined with the ESC prognostic algorithm for the prediction of 30-day mortality improved the discriminatory capacity of the model and enabled reclassification in different risk categories in 27% of the patients (Table 1). Conclusion Renal function impairment increases the rate of adverse events after acute PE. Combined with the ESC early mortality risk score, eGFR improves risk classification. Model fit, discrimination, prognostic performances, and reclassification indices when eGFRCKD-EPI is added to the European Society of Cardiology prognostic algorithm for the prediction of the 30-day all-cause death after an acute pulmonary embolism. Disclosure of interest The authors declare that they have no competing interest.
https://doi.org/10.1016/j.acvdsp.2019.09.407 036
Outcomes and incremental prognostic value of renal dysfunction after acute pulmonary embolism R. Chopard 1 , G. Serzian 1 , F. Ecarnot 1,∗ , S. Humbert 2 , N. Falvo 3 , M. Morel-Aleton 4 , B. Bonnet 5 , G. Napporn 6 , E. Kalbacher 7 , L. Obert 8 , B. Degano 9 , G. Capellier 10 , F. Schiele 1 , Nicolas Meneveau 1 1 Cardiologie, Besanc ¸on 2 Internal Medicine, CHU de Besanc ¸on, Besanc¸on 3 Internal Medicine, CHU de Dijon, Dijon 4 Centre Hospitalier, Pontarlier 5 Centre Hospitalier de Vesoul, Vesoul 6 Cardiologie, Centre Hospitalier Louis Pasteur, Dole 7 Oncologie Médicale 8 Chirurgie orthopédique, traumatologique et plastique 9 Physiologie - Explorations Fonctionnelles 10 Réanimation Médicale, CHU de Besanc ¸on, Besanc¸on, France ∗ Corresponding author. E-mail address: fi[email protected] (F. Ecarnot)
https://doi.org/10.1016/j.acvdsp.2019.09.408 026
Early prescription of direct oral anticoagulants for acute intermediate-high risk pulmonary embolism C. Eveno ∗ , R. Chopard , N. Meneveau , F. Schiele Cardiologie, CHRU Jean-Minjoz, Besanc¸on, France
Background Outcomes in patients with acute pulmonary embolism (PE) and renal function impairment are unknown. We
Table 1 Without eGFR OR (95%CI) ESC Prognostic algorithm eGFR CKD-EPI Measures of fit Bayes information criterion Akaike information criterion C-statistic P (Hosmer-Lemeshow) Integrated discrimination improvement Net Reclassification Improvement Prognostic performances Sensitivity Specificity Positive predictive value Negative predictive value Positive likelihood ratio Negative likelihood ratio Youden index
CKD-EPI
With eGFR CKD-EPI OR (95%CI)
2.59 (1.95—3.43)
2.30 (1.72—3.07) 2.60 (1.62—4.70)
607.30 596.47 0.71* 0.057
599.32 583.06 0.77** 0.43 0.054 (0.052—0.056) 0.93 (0.90—0.95)
62.5 64.2 10.1 97.0 1.96 0.50 0.31
76.2 69.9 16.2 98.1 2.12 0.54 0.39
(51.2—72.3) (49.1—74.4) (8.2—11.3) (96.0—98.0) (1.12—3.41) (0.25—1.81) (0.28—0.34)
(61.5—90.2) (47.6—83.5) (14.2—18.2) (97.2—99.2) (1.54—3.12) (0.20—1.56) (0.36—0.41)
eGFRCKD-EPI : estimated glomerular filtration using the Chronic Kidney Disease-Epidemiology Collaboration equation (CKDEPI ) with a threshold value of 55 ml/min/1.73 m2 . ESC: European Society of Cardiology. * Difference in c-statistic: P = 0.03 ** Difference in c-statistic: P = 0.04.