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

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.