Clinical Syndromes and Clinical Outcome in Patients with Pulmonary Embolism. Findings from the RIETE Registry

Hospital Universitari de Girona Dr. Josep Trueta, Girona, Catalonia, Spain
Chest (Impact Factor: 7.48). 01/2007; 130(6):1817-22. DOI: 10.1378/chest.130.6.1817
Source: PubMed


The influence of the clinical syndromes of pulmonary embolism (PE) on clinical outcome has not been evaluated.
The Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) is an ongoing registry of consecutive patients with acute venous thromboembolism. In this study, all enrolled patients with acute PE without preexisting cardiac or pulmonary disease were classified into three clinical syndromes: pulmonary infarction, isolated dyspnea, or circulatory collapse. Their clinical characteristics, laboratory findings, and 3-month outcomes were compared.
As of January 2005, 4,145 patients with acute, symptomatic, objectively confirmed PE have been enrolled in RIETE. Of them, 3,391 patients (82%) had no chronic lung disease or heart failure: 1,709 patients (50%) had pulmonary infarction, 1,083 patients (32%) had isolated dyspnea, and 599 patients (18%) had circulatory collapse. Overall, 149 patients (4.4%) died during the first 15 days of therapy: 2.5% with pulmonary infarction, 6.2% with isolated dyspnea (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.7 to 3.8), and 6.5% with circulatory collapse (OR, 2.7; 95% CI, 1.7 to 4.2). From days 16 to 90, 31 patients had recurrent PE; 5 of 14 patients (36%) with pulmonary infarction died of their new PE, compared with 5 of 10 patients (50%) with isolated dyspnea, and all 7 patients (100%) with circulatory collapse.
PE patients with pulmonary infarction (50% of the whole series) had a significantly lower mortality rate both during initial therapy and after discharge.

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    • "One possible explanation of this disparity could be the observed younger age of patients in the present study compared with others. In the RIETE registry about 50% of patients were older than 70 years[12] Similarly, Ceylan et al. reported the mean age of their patients with PE to be 63 years.[13] This racial difference in age of presentation and mortality from PE has been described before, where Blacks were found to present at a younger age than Whites (57.7 vs. 64.8 "
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    ABSTRACT: The objective of this study is to determine the outcome of pulmonary embolism (PE) and the clinico-radiological predictors of mortality in a university hospital setting. A Prospective observational study conducted at King Khalid University Hospital, Riyadh Saudi Arabia between January 2009 and 2012. A total of 105 consecutive patients (49.9 ± 18.7 years) with PE diagnosed by computed tomography pulmonary angiography were followed until death or hospital discharge. Overall in hospital mortality rate was 8.6%, which is lower than other international reports. Two-thirds of patients developed PE during the hospitalization. The most common risk factors were surgery (35.2%), obesity (34.3%) and immobility (30.5%). The localization of the embolus was central in 32.4%, lobar in 19% and distal in 48.6%. A total of 26 patients (25%) had evidence of right ventricular strain and 14 (13.3%) were hypotensive. Multivariate analysis revealed that heart failure (Beta = -0.53, P < 0.001), palpitation (Beta = -0.24, P = 0.014) and high respiratory rate (Beta = -0.211, P < 0.036) were significant predictors of mortality. There was no significant difference in the localization of the embolus or obstruction score between survivors and non-survivors. The outcome of PE is improving; however, it remains an important risk factor for mortality in hospitalized patients. Congestive heart failure, tachypnea and tachycardia at presentation were associated with higher mortality. These factors need to be considered for risk stratification and management decisions of PE patients. Radiological quantification of clot burden was not a predictor of death.
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    • "Inversely, history of VTE is usually accepted as a predisposing factor for recurrence [21] [22], but not for death. Haemoptysis occurred when the PE resulted in pulmonary infarction , a clinical presentation associated with better survival than isolated dyspnoea or circulatory collapse [20]. "
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    ABSTRACT: Background: Assessment of pre-test probability of pulmonary embolism (PE) and prognostic stratification are two widely recommended steps in the management of patients with suspected PE. Some items of the Geneva prediction rule may have a prognostic value. We analyzed whether the initial probability assessed by the Geneva rule was associated with the outcome of patients with PE. Methods: In a post-hoc analysis of a multicenter trial including 1,693 patients with suspected PE, the all-cause death or readmission rates during the 3-month follow-up of patients with confirmed PE were analyzed. PE probability group was prospectively assessed by the revised Geneva score (RGS). Similar analyses were made with the a posteriori-calculated simplified Geneva score (SGS). Results: PE was confirmed in 357 patients and 21 (5.9%) died during the 3-month follow-up. The mortality rate differed significantly with the initial RGS group, as with the SGS group. For the RGS, the mortality increased from 0% (95% Confidence Interval: [0-5.4%]) in the low-probability group to 14.3% (95% CI: [6.3-28.2%]) in the high-probability group, and for the SGS, from 0% (95% CI: [0-5.4%] to 17.9% (95% CI: [7.4-36%]). Readmission occurred in 58 out of the 352 patients with complete information on readmission (16.5%). No significant change of readmission rate was found among the RGS or SGS groups. Conclusions: Returning to the initial PE probability evaluation may help clinicians predict 3-month mortality in patients with confirmed PE. ( NCT00117169).
    Full-text · Article · May 2013 · Thrombosis Research

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