YEARS algorithm in suspected pulmonary embolism: Towards a reduced rate of pulmonary imaging

August 30, 2016

This press release accompanies both a presentation and an ESC press conference at the ESC Congress 2016. Edited by the ESC from material supplied by the investigators themselves, this press release does not necessarily reflect the opinion of the European Society of Cardiology. The content of the press release has been approved by the presenter.

Rome, Italy - 30 August, 2016 : Patients with suspected pulmonary embolism (PE) often undergo computed tomography pulmonary angiography (CTPA) to confirm or exclude the diagnosis.

However, CTPA exposes them to radiation, the risk of contrast-induced nephropathy, and increases health care costs. Therefore ways to reduce the use of CTPA in this setting are needed.

Now, new findings presented at ESC Congress 2016, suggest a simple diagnostic algorithm can be used to rule out PE in a significant number of these patients, eliminating their need for CTPA.

The YEARS algorithm "can replace current diagnostic algorithms which, although safe and accurate, are often not used in busy emergency departments because they are too complex," noted YEARS study investigator Tom van der Hulle, MD, from Leiden University Medical Center, in the Netherlands.

"The advantage of the YEARS algorithm over existing algorithms is a 14% reduction in the need for CTPA imaging and with that, reduced potential for radiation-induced harm and overdiagnosis." Unlike other, multi-item, sequential algorithms used to assess PE risk, the YEARS clinical decision rule consists of one blood test and 3 items of the original Wells rule.

Patients presenting to the emergency department can be evaluated based on: Using this information combined with results of a blood test measuring D-dimer - a protein produced by blood clots - clinicians can either exclude PE, or recommend a CTPA for definitive diagnosis.

The YEARS study prospectively evaluated this algorithm in 3,465 patients (mean age 53 years), 88% of whom 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>

All other patients were referred for CTPA.

Patients in whom PE was excluded were left untreated and followed for 3 months, while those diagnosed with PE were treated with anticoagulants.

The primary outcome of the study was the 3-month incidence of symptomatic venous thromboembolism (VTE), which occurred in 0.43% of patients who had PE excluded based on the YEARS algorithm alone and 0.84% of the patients who had PE excluded based on CTPA.

"This is fully in line with that observed in studies using traditional, sequential algorithms such as the 2-level Wells score, and a fixed cut-off level of D-dimer of 500 ng/mL," noted Dr. van der Hulle. "Using the YEARS algorithm, CTPA was not indicated in 48% of our patients at baseline, but this would have been only 34% of patients using the traditional algorithm. This shows that the YEARS algorithm can safely exclude PE and resulted in an absolute reduction of required CPTA of 14%."

He added, "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."
-end-
Notes to editors

Sources of funding: The study was supported by unrestricted grants from the participating hospitals.

Disclosures: Dr. van der Hulle has no relevant disclosures.

ESC Press Office


For background information, please contact the ESC Press Office at media@escardio.org.

For press enquiries, please contact, the Media & Press Coordinator, Jacques Olivier Costa: +393427028575 F

or independent comment on site, please contact the ESC Spokesperson coordinator, Celine Colas: +393402405148

To access all the scientific resources from the sessions during the congress, visit ESC Congress 365.

About the European Society of Cardiology


The European Society of Cardiology brings together health care professionals from more than 120 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

About ESC Congress 2016

ESC Congress is the world's largest gathering of cardiovascular professionals contributing to global awareness of the latest clinical trials and breakthrough discoveries. ESC Congress 2016 takes place 27 to 31 August at the Fiera di Roma in Rome, Italy. The scientific programme is here. More information is available from the ESC Press Office at press@escardio.org

European Society of Cardiology

Related Algorithm Articles from Brightsurf:

CCNY & partners in quantum algorithm breakthrough
Researchers led by City College of New York physicist Pouyan Ghaemi report the development of a quantum algorithm with the potential to study a class of many-electron quantums system using quantum computers.

Machine learning algorithm could provide Soldiers feedback
A new machine learning algorithm, developed with Army funding, can isolate patterns in brain signals that relate to a specific behavior and then decode it, potentially providing Soldiers with behavioral-based feedback.

New algorithm predicts likelihood of acute kidney injury
In a recent study, a new algorithm outperformed the standard method for predicting which hospitalized patients will develop acute kidney injury.

New algorithm could unleash the power of quantum computers
A new algorithm that fast forwards simulations could bring greater use ability to current and near-term quantum computers, opening the way for applications to run past strict time limits that hamper many quantum calculations.

QUT algorithm could quash Twitter abuse of women
Online abuse targeting women, including threats of harm or sexual violence, has proliferated across all social media platforms but QUT researchers have developed a sophisticated statistical model to identify misogynistic content and help drum it out of the Twittersphere.

New learning algorithm should significantly expand the possible applications of AI
The e-prop learning method developed at Graz University of Technology forms the basis for drastically more energy-efficient hardware implementations of Artificial Intelligence.

Algorithm predicts risk for PTSD after traumatic injury
With high precision, a new algorithm predicts which patients treated for traumatic injuries in the emergency department will later develop posttraumatic stress disorder.

New algorithm uses artificial intelligence to help manage type 1 diabetes
Researchers and physicians at Oregon Health & Science University have designed a method to help people with type 1 diabetes better manage their glucose levels.

A new algorithm predicts the difficulty in fighting fire
The tool completes previous studies with new variables and could improve the ability to respond to forest fires.

New algorithm predicts optimal materials among all possible compounds
Skoltech researchers have offered a solution to the problem of searching for materials with required properties among all possible combinations of chemical elements.

Read More: Algorithm News and Algorithm Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.