YEARS: Algorithm Could Help Clinicians Rule Out Pulmonary Embolism Without CTPA
The YEARS algorithm may provide a simple and accurate way to rule out suspected pulmonary embolism (PE) without the need for patients to undergo computed tomography pulmonary angiography (CTPA), according to results from the YEARS study presented Aug. 30 during ESC Congress 2016 in Rome.
Unlike other, multi-item, sequential algorithms used to assess PE risk, the YEARS algorithm consists of one blood test measuring D-dimer and whether patients presenting to the emergency department have clinical signs of deep vein thrombosis (e.g., swelling, edema); hemoptysis (coughing up blood); and whether the clinician considers PE to be “the most likely diagnosis.”
Researchers prospectively evaluated the YEARS algorithm in 3,465 patients (mean age 53 years), of whom 88 percent were outpatients. Based on the algorithm, PE was excluded and CPTA was withheld in 1,651 patients who either had: no YEARS items and a D-dimer level <1000 ng/mL; or one or more YEARS items and a D-dimer level <500 ng/mL. All other patients were referred for CTPA. Patients in whom PE was excluded were left untreated and followed for three months, while those diagnosed with PE were treated with anticoagulants.
The primary outcome – three-month incidence of symptomatic venous thromboembolism – occurred in 0.43 percent of patients who had PE excluded based on the YEARS algorithm alone and 0.84 percent of patients who had PE excluded based on CTPA.
“The advantage of the YEARS algorithm over existing algorithms is a 14 percent reduction in the need for CTPA imaging and with that, reduced potential for radiation-induced harm and overdiagnosis,” said Tom Van der Hulle, MD, from Leiden University Medical Center, Netherlands. “We expect that the YEARS algorithm can be easily implemented outside the participating study sites, and that these safety and efficacy outcomes are representative of what could be expected in regular clinical settings.”
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