Background: Cardiac biomarkers or echocardiography for assessing right ventricular function are recommended to risk-stratify patients with acute non-massive pulmonary embolism (PE) but it remains unclear whether these tests affect the management and clinical outcomes in daily practice.
Methods and results: Overall, 587 patients with acute non-massive PE from 18 hospitals were enrolled in the Swiss Venous Thromboembolism Registry (SWIVTER) of whom 178 (30%) neither had a biomarker test nor an echocardiographic evaluation. Compared to the 409 (70%) patients with biomarkers or echocardiography of whom 210 (51%) had at least one positive test, patients without any testing were younger (61±18 vs. 67±16 years; p<0.001), more often outpatient at diagnosis (64% vs. 46%; p<0.001), had more often provoked PE (45% vs. 34%; p=0.010) and cancer (32% vs. 22%; p=0.015), and had less frequently main pulmonary artery embolism (26% vs. 37%, p=0.009) or an increased PE severity index (59% vs. 70%; p=0.012). The hospitalization rates were 80% without vs. 93% with testing (p<0.001); thrombolysis and/or embolectomy were performed in 2.8% vs. 4.9% (p=0.29), and the 30-day rates of mortality and PE recurrence were 7.4% vs. 3.2%, respectively (p=0.031). The predictive value of biomarker testing or echocardiography was lost (HR 0.62, 95%CI 0.27-1.39; p=0.24) when adjusted for other univariate predictors of mortality and recurrent PE, including cancer, chronic lung disease and bleeding complications. Conclusions: Although more than two thirds of the PE patients underwent risk assessment with a biomarker test or an echocardiogram, such testing had little impact on management and clinical outcomes.