Pulmonary embolism (PE) patients with right ventricular (RV) involvement are a heterogenous group who mandate further risk stratification. Our objective was to evaluate the efficacy of the PE severity index (PESI) for predicting adverse clinical outcomes among PE patients with RV involvement. Consecutive normotensive PE patients with RV involvement were allocated according to admission PESI score (PESI ≤ III vs. PESI ≥ IV). The primary outcome included hemodynamic instability and in-hospital mortality. Secondary outcomes included each component of the primary outcome as well as mechanical ventilation, thrombolytic therapy, acute kidney injury, and major bleeding. Multivariable logistic regression model was performed to assess the independent association between the PESI score and primary outcome. C-Statistic was used to compare the PESI with the BOVA score. A total of 253 patients were evaluated: 95 (38%) with a PESI ≥ IV. Of them, 82 (32%) patients were classified as intermediate–low risk and 171 (68%) as intermediate–high risk. Fifty (20%) patients had at least 1 adverse event. Multivariate analysis demonstrated the PESI to be an independent predictor for the primary outcome (HR 4.81, CI 95%, 1.15–20.09, p = 0.031), which was increased with a concomitant increase of the PESI score (PESI I 4.2%, PESI II 3.4%, PESI III 12%, PESI IV 16.3%, PESI V 23.1%, p for trend < 0.001). C-Statistic analysis for the PESI score yielded an AUC-0.746 (0.637–0.854), p = 0.001, compared to the BOVA score: AUC-0.679 (0.584–0.775), p = 0.011. PESI score was found to predict adverse outcomes among normotensive PE patients with RV involvement.

右心室 (RV) 受累的肺栓塞 (PE) 患者是一个异质性群体，需要进一步进行风险分层。我们的目标是评估 PE 严重程度指数 (PESI) 在预测 RV 受累的 PE 患者的不良临床结果方面的功效。根据入院 PESI 评分（PESI ≤ III 与 PESI ≥ IV）分配有 RV 受累的连续血压正常的 PE 患者。主要结局包括血流动力学不稳定和住院死亡率。次要结局包括主要结局的每个组成部分以及机械通气、溶栓治疗、急性肾损伤和大出血。采用多变量逻辑回归模型评估 PESI 评分与主要结果之间的独立关联。C-Statistic 用于比较 PESI 和 BOVA 评分。共评估了 253 名患者：95 名 (38%) 患者的 PESI ≥ IV。其中，82 名 (32%) 患者被归类为中低风险，171 名 (68%) 患者被归类为中高风险。五十 (20%) 名患者至少有 1 起不良事件。多变量分析表明，PESI 是主要结果的独立预测因子（HR 4.81，CI 95%，1.15–20.09，p  = 0.031），随着 PESI 评分的增加而增加（PESI I 4.2%，PESI II 3.4%，PESI III 12%，PESI IV 16.3%，PESI V 23.1%，趋势p < 0.001）。PESI 评分的 C 统计分析得出 AUC-0.746 (0.637–0.854)，p  = 0.001，而 BOVA 评分：AUC - 0.679 (0.584–0.775)，p  = 0.011。PESI 评分被发现可预测右室受累的血压正常的 PE 患者的不良结局。