OC 11.2 - Pulmonary embolism diagnostic strategies in patients with COPD exacerbation: post-hoc analysis of the PEP trial

Sunday, June 25, 2023

11:00 – 11:15 ET

Room: 516

Session Available As: Live-Stream and On-Demand

Presenting Author(s)

Vicky Mai, MD MSc (she/her/hers)

MD, MSc
Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
Ottawa, Ontario, Canada

Co-Author(s)

GR

Geoffroy Rambaud

MD
Service des urgences, Centre Hospitalo-Universitaire de Brest, INSERM U1304, Univ_Brest, Brest, FCRIN INNOVTE, France
Brest, Bretagne, France
CM

Camille Motreff

BHSc
Centre Hospitalo-Universitaire de Brest, Département de Médecine Interne et Pneumologie, INSERM U1304, CIC INSERM 1412, Univ_Brest, Brest, FCRIN INNOVTE, France.
Brest, Bretagne, France
Olivier Sanchez, MD, PhD

Head of department
Université Paris Cité, Service de Pneumologie et Soins Intensifs, HEGP
Paris, France
Pierre-Marie Roy, MD, PhD (he/him/his)

MD, PhD
Service des urgences, Centre Hospitalo-Universitaire d’Angers, Institut MITOVASC, EA 3860, Université d'Angers, Angers, FCRIN INNOVTE, France.
Angers, Pays de la Loire, France
RL

Raphael Le Mao

MD
Centre Hospitalo-Universitaire de Brest, Département de Médecine Interne et Pneumologie, INSERM U1304, CIC INSERM 1412, Univ_Brest, Brest, FCRIN INNOVTE, France.
Brest, Bretagne, France
FG

Frederic Gagnadoux

MD, PhD
Département de Pneumologie, Centre Hospitalo-Universitaire d’Angers, INSERM UMR1063, Université d’Angers, France.
Anger, Pays de la Loire, France
NP

Nicolas Paleiron

MD, MS
Service de pneumologie-allergologie-cancérologie thoracique, HIA Sainte Anne, Toulon, FCRIN INNOVTE, France
Toulon, Provence-Alpes-Cote d'Azur, France
JS

Jeannot Schmidt

MD
Service des urgences, Centre Hospitalo-Universitaire de Clermont-Ferrand, UMR 6024 UCA-CNRS, Clermont-Ferrand, FCRIN INNOVTE, France.
Clermont-Ferrand, Auvergne, France
MN

Michel Nonent

MD, PhD
Service de radiologie, Centre Hospitalo-Universitaire de Brest, INSERM U1304, Univ_Brest, Brest, FCRIN INNOVTE, France.
Brest, Bretagne, France
CT

Cecile Tromeur

MD, PhD
Centre Hospitalo-Universitaire de Brest, Département de Médecine Interne et Pneumologie, INSERM U1304, CIC INSERM 1412, Univ_Brest, Brest, FCRIN INNOVTE, France.
Brest, Bretagne, France
PS

Pierre-Yves Salaun

MD, PhD
Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, Service de Médecine Nucléaire, UMR 1304, Univ_Brest, Brest, FCRIN INNOVTE, France.
Brest, Bretagne, France
PM

Patrick Mismetti

MD, PhD
Service de Médecine Vasculaire et Thérapeutique, Centre Hospitalo-Universitaire de Saint-Etienne ; INSERM CIC 1408 CHU de St-Etienne; INSERM UMR 1059, Université Jean Monnet, Saint-Etienne ; FCRIN INNOVTE, France.
Sainte-Etienne, Pays de la Loire, France
PG

Philippe Girard

MD
Département Thoracique, Institut Mutualiste Montsouris; Paris, FCRIN INNOVTE, France.
Paris, Ile-de-France, France
KL

Karine Lacut

MD, PhD
Centre Hospitalo-Universitaire de Brest, Département de Médecine Interne et Pneumologie, INSERM U1304, CIC INSERM 1412, Univ_Brest, Brest, FCRIN INNOVTE, France.
Brest, Bretagne, France
GM

Guy Meyer

MD
Service de Pneumologie et de Soins Intensifs, Hôpital Européen Georges Pompidou, AP-HP; INSERM UMR S 970, Université de Paris, Paris; FCRIN INNOVTE, France.
Paris, Ile-de-France, France
CL

Christophe Leroyer

MD, PhD
Centre Hospitalo-Universitaire de Brest, Département de Médecine Interne et Pneumologie, INSERM U1304, CIC INSERM 1412, Univ_Brest, Brest, FCRIN INNOVTE, France.
Brest, Bretagne, France
Gregoire Le Gal, MD PhD

MD, PhD
Ottawa Hospital Research Institute, University of Ottawa, Canada
Ottawa, Ontario, Canada
Laurent Bertoletti, MD, PhD (he/him/his)

MD, PhD
Service de Médecine Vasculaire et Thérapeutique, Centre Hospitalo-Universitaire de Saint-Etienne ; INSERM CIC 1408 CHU de St-Etienne; INSERM UMR 1059, Université Jean Monnet, Saint-Etienne ; FCRIN INNOVTE, France.
Saint-Etienne, Rhone-Alpes, France
Francis Couturaud, PhD (he/him/his)

MD, PhD
Centre Hospitalo-Universitaire de Brest, Département de Médecine Interne et Pneumologie, INSERM U1304, CIC INSERM 1412, Univ_Brest, Brest, FCRIN INNOVTE, France.
Brest, Bretagne, France

Background: The prevalence of pulmonary embolism (PE) is approximately 11-17% in patients with an acute exacerbation of chronic obstructive pulmonary disease (AE-COPD). The optimal diagnostic strategy for PE in these patients remains undetermined.

Aims: To evaluate the safety and efficacy of standard (revised Geneva and Wells PE scores combined with fixed D-dimer cut-off) and computed tomography pulmonary angiogram (CTPA)-sparing diagnostic strategies (ADJUST-PE, YEARS, PEGeD, 4PEPS) in patients with AE-COPD.

Methods: Post-hoc analyses of data from the multicenter prospective PEP study were conducted. The primary outcome was the diagnostic failure rate of venous thromboembolism (VTE) during the entire study period. Secondary outcomes included diagnostic failure rate of PE and deep venous thrombosis (DVT), respectively, during the entire study period and the number of CTPA needed per diagnostic strategy.

Results: 740 patients were included. The revised Geneva and Wells PE scores combined with fixed D-dimer cut-off had a diagnostic failure rate of VTE of 0.7% (95%CI 0.3%-1.7%), but >70.0% of the patients needed imaging. All CTPA-sparing diagnostic algorithms reduced the need for CTPAs (-10.1% to -32.4%, depending on the algorithm), at the cost of an increased VTE diagnosis failure rate of up to 2.1% (95%CI 1.2%-3.4%).

Conclusion(s): Revised Geneva and Wells PE scores combined with fixed D-dimer cut-off were safe, but a high number of CTPA remained needed. CTPA-sparing algorithms would reduce imaging, at the cost of an increased VTE diagnosis failure rate that exceeds the safety threshold. Further studies are needed to improve diagnostic management in this population.

Learning Objectives:

To evaluate the safety and efficacy of the revised Geneva and Wells pulmonary embolism (PE) scores combined with fixed D-Dimer cut-off in patients with chronic obstructive pulmonary disease (COPD) exacerbation.
To evaluate the safety and efficacy of computed tomography pulmonary angiogram (CTPA)-sparing strategies (ADJUST-PE, YEARS, PEGeD, 4PEPS) in patients with COPD exacerbation.
To evaluate the diagnostic failure rate of venous thromboembolism, PE and deep venous thrombosis, respectively, during the entire study period and the number of CTPA needed per diagnostic strategy.