OBJECTIVE: To assess the performance of 2 prognostic models (the European Society of Cardiology [ESC] model and the simplified Pulmonary Embolism Severity Index [sPESI]) in predicting short-term mortality in patients with pulmonary embolism (PE).

METHODS: We compared the test characteristics of the ESC model and the sPESI for predicting 30-day outcomes in a cohort of 526 patients with objectively confirmed PE. The primary end point of the study was all-cause mortality. The secondary end point included all-cause mortality, nonfatal symptomatic recurrent VTE, or nonfatal major bleeding.

RESULTS: Overall, 40 out of 526 patients died (7.6%; 95% confidence interval [CI], 5.3% to 9.9%) during the first month of follow-up. The sPESI classified fewer patients as low risk (31% [165/526], 95% CI: 27% to 35%) compared to the ESC model (39% [207/526], 95% CI: 35% to 44%; P < 0.01). Importantly however, low-risk patients based on the sPESI had no 30-day mortality compared to 3.4% (95% CI, 0.9-5.8) in low-risk patients by the ESC model. The secondary end point occurred in 1.8% of patients in the sPESI low-risk and 5.8% in the ESC low-risk group (difference, 4.0 percentage points; 95% CI, 0.2 to 7.8). The prognostic ability of the ESC model remained significant in the subgroup of patients at high-risk according to the sPESI model (OR 1.95, 95% CI 1.41 to 2.71, P < 0.001).

CONCLUSIONS: Both the sPESI and the ESC model successfully predict 30-day mortality after acute symptomatic PE, but exclusion of an adverse early outcome does not appear to require routine imaging procedures or laboratory biomarker testing.