• Yugo Yamashita, Takeshi Morimoto, Hidewo Amano, Toru Takase, Seiichi Hiramori, Kitae Kim, Maki Oi, Masaharu Akao, Yohei Kobayashi, Mamoru Toyofuku, Toshiaki Izumi, Tomohisa Tada, Po-Min Chen, Koichiro Murata, Yoshiaki Tsuyuki, Syunsuke Saga, Tomoki Sasa, Jiro Sakamoto, Minako Kinoshita, Kiyonori Togi, Hiroshi Mabuchi, Kensuke Takabayashi, Hiroki Shiomi, Takao Kato, Takeru Makiyama, Koh Ono, and Takeshi Kimura.
• Department of Cardiovascular Medicine, Kyoto University, Japan.
• Eur Heart J Acute Cardiovasc Care. 2020 Jun 1; 9 (4): 262-270.

BackgroundThe simplified pulmonary embolism severity index (sPESI) score has been reported to be useful in predicting 30-day mortality for patients with pulmonary embolism, which helps the identification of low-risk patients for early hospital discharge or home treatment. However, therapeutic decision-making should also be based on the risks of adverse events other than mortality.MethodsThe COMMAND VTE Registry is a multicentre registry enrolling consecutive patients with acute symptomatic venous thromboembolism in Japan between January 2010 and August 2014, and the current study population consisted of 1715 patients with pulmonary embolism. We calculated the sPESI score for each patient, and compared 30-day rates of mortality, recurrent venous thromboembolism and major bleeding between sPESI scores of 0 and 1 or greater.ResultsPatients with a sPESI score of 0 accounted for 383 (22%) patients, and 110 (6.4%) patients died within 30 days. The cumulative 30-day incidence of mortality was lower in patients with a sPESI score of 0 than those with a sPESI score of 1 or greater (0.5% vs. 8.1%, log rank P<0.001). There was no significant difference in the cumulative 30-day incidence of recurrent venous thromboembolism between patients with a sPESI score of 0 and 1 or greater (1.3% vs. 2.8%, log rank P=0.11). The cumulative 30-day incidence of major bleeding was lower in patients with a sPESI score of 0 than those with a sPESI score of 1 or greater (1.1% vs. 4.0%, log rank P=0.005).ConclusionsIn patients with a sPESI score of 0, the 30-day mortality, recurrent venous thromboembolism and major bleeding rates were reasonably low. The sPESI score could be useful to identify candidates for early hospital discharge or home treatment.

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