Incorporating the Composite PE Shock (CPES) score with PESI and ESC risk classification improved 30-day mortality prediction (AUROC 0.713 vs 0.710 for PESI+ESC alone; NRI 6.4%).
Observational (n=404)
Yes
Does the addition of the Composite PE Shock (CPES) score to PESI and ESC risk classification improve prognostic accuracy for 30-day mortality and major bleeding in patients with acute pulmonary embolism?
Incorporating the novel Composite PE Shock (CPES) score alongside standard PESI and ESC risk classifications modestly improves the accuracy of predicting 30-day mortality in patients with acute pulmonary embolism.
Abstract Rationale Annually, 370,000 people in the United States are affected by acute pulmonary embolism (PE). Mortality rates for acute PE vary widely depending on severity of acute PE and can range from 1% for low-risk patients to at least 30 % for high-risk patients. PE Severity Index (PESI) and European Society of Cardiology (ESC) classification are commonly used for risk stratification of patients with acute PE. The Composite PE Shock (CPES) score is a novel score that is thought to be more useful for patients with risk factors associated with normotensive shock. In the present study, we compared prognostic performance of PESI, ESC risk classification and CPES for patients with acute PE. Methods A retrospective chart review of all patients with acute PE managed by PERT at one of three urban teaching hospitals within the Mount Sinai Health System from January 2020 to June 2024 was performed. CPES risk factors that were identified included elevated troponin, BNP, reduced right ventricular function on echo, saddle PE, deep venous thrombosis, and tachycardia. Primary outcomes included 30-day mortality and major bleeding. Logistic regression models were constructed to predict primary outcomes from each prognostic score. Receiver operating characteristic (ROC) curves were built and area under the ROC curve (AUROC) were compared for each score. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were calculated to assess the incremental utility of CPES over PESI and ESC risk classification. Results A total of 404 patients (n = 223, 55.2% female) with median age of 65 (IQR: 53‒76) years (n = 26, 41.9% female) were included. Median PESI and CPES scores were 82 (IQR: 66‒104) and 3 (IQR: 2‒4) points. Based on ESC risk stratification, 12 (3.0%), 71 (17.6%), 235 (58.2%) and 86 (21.3%) had low-, intermediate low-, intermediate high- and high-risk acute PE. AUROC of PESI score, ESC risk classification, CPES, two-index model (PESI + ESC risk class) and full model (PESI + ESC risk class + CPES) for predicting 30-day mortality were 0.706, 0.643, 0.420, 0.710 and 0.713 respectively (Figure 1). The full model increased the specificity of the two-index model by 10% for predicting 30-day mortality while decreasing the sensitivity by 3.6%, thereby affording an NRI of 6.4%. The IDI for full model when compared to the two-index model was 1.3%. Conclusion Among patients with acute PE managed by PERT, incorporation of CPES along with PESI and ESC risk class improved prognostication by increasing accuracy of predicting 30-day mortality. This abstract is funded by: None
Wang et al. (2026) conducted an observational in acute pulmonary embolism (PE) (n=404). Composite PE Shock (CPES) score added to PESI and ESC risk classification vs. PESI and ESC risk classification alone was evaluated on 30-day mortality and major bleeding. Incorporating the Composite PE Shock (CPES) score with PESI and ESC risk classification improved 30-day mortality prediction (AUROC 0.713 vs 0.710 for PESI+ESC alone; NRI 6.4%).
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