FILMED AT THE EUROPEAN SOCIETY OF CARDIOLOGY (ESC) ANNUAL MEETING, AUGUST 2016
AT THE MEETING YOU ARE PRESENTING ON THE YEARS STUDY. COULD YOU DESCRIBE THE DIAGNOSTIC MANAGEMENT ALGORITHM?
00:11 – In the YEARS study we investigated a new diagnostic algorithm for patients with suspected pulmonary embolism. And it starts with ordering a D-dimer test, and then you have to score three items which are the presence of signs of deep vein thrombosis, haemoptysis and whether you think pulmonary embolism is the most likely diagnosis. And in case none of these items are present, you can use a D-dimer threshold of thousand instead of the 500 we use today. And in case of one or more of the YEARS items are present, you can use a D-dimer threshold of 500. And in case of a D-dimer concentration below the threshold you have excluded pulmonary embolism, and in the other cases you have to order a CT scan.
HOW DOES THIS DIFFER FROM CURRENT ALGORITHMS?
01:01 – The current algorithms you have to start with the assessment of the clinical probability which you have to use the Wells rule or the revised Geneva score, which consists of seven to nine items with all different ranging. And we use only three items with the same weight of one. And in our algorithm we use a D-dimer test in all patients which is only used in patients with a low clinical probability in the standard algorithm. That are the main differences.
WHAT ARE THE ADVANTAGES AND DISADVANTAGES OF USING COMPUTED TOMOGRAPHY PULMONARY ANGIOGRAPHY (CTPA) FOR DIAGNOSIS OF PULMONARY EMBOLISM (PE)?
01:39 – The CT scan is to recommend the non-invasive diagnostic test to diagnose pulmonary embolism, but the disadvantages are the radiation exposure and the need for intravenous contrast which is associated with contrast-induced nephropathy and allergic reactions. And also, a CT scan costs money, so therefore it’s important to reduce the number of CT scans.
WHAT ARE THE KEY FINDINGS OF YOUR STUDY?
02:06 – The key finding is that the YEARS algorithm is able to exclude pulmonary in a safe way and to reduce the number of CT scans by up to 14%.
WHAT ARE THE LIMITATIONS OF APPLYING D-DIMER THRESHOLDS?
02:19 – The limitation of the D-Dimer threshold is that you have to find the optimal threshold in order to exclude pulmonary embolism in the largest proportion of patients possible, without losing or missing any diagnosis of pulmonary embolism.