Background-There are currently no guidelines advising long-term surveillance of patients following an acute pulmonary embolism (PE), because long-term outcome studies are rare. We investigated the long-term cardiovascular and all-cause mortality of a large patient cohort with confirmed PE in relation to baseline cardiovascular disease (CVD). Methods and Results-Clinical details of all patients presenting with acute PE to a tertiary hospital were retrieved from medical records, and their survival tracked from a statewide death registry. There were 1023 (45% males) patients admitted with confirmed PE from 2000 to 2007. During a mean follow-up of 3.8Ϯ2.6 years, 363 patients died (35.5%), of whom only 31 (3.0%) died in-hospital during the index PE admission. The 3-month, 6-month, 1-year, 3-year, and 5-year cumulative mortality rates were 8.3%, 11.1%, 16.3%, 26.7%, and 31.6% respectively. Annual mortality did not improve over the 7-year period. The postdischarge mortality of 8.5%/patient-year was 2.5-fold that of an age-and sex-matched general population, being 12.6-fold in the youngest quintile (Ͻ55 years) and 1.9-fold in the oldest quintile (Ն83 years). Patients with known CVD at baseline had 2.2-fold greater all-cause mortality than those without CVD, and this effect, although at a lower level of risk, remained significant after multivariate analysis. Of the 332 deaths occurring postdischarge, 40% were attributed to cardiovascular causes. Conclusions-In a contemporary adult population, PE is associated with a substantially increased long-term mortality, of which nearly half is cardiovascular. Our study highlights the urgent need to develop long-term surveillance strategies in this population. (Circ Cardiovasc Qual Outcomes. 2011;4:122-128.)Key Words: pulmonary embolism Ⅲ long-term Ⅲ mortality Ⅲ predictors Ⅲ cardiovascular Ⅲ heart disease Ⅲ thrombosis V enous thromboembolic disease is a worldwide problem, with acute pulmonary embolism (PE) its most severe manifestation. 1 The outcome of patients with acute PE is only partly (and to a small extent) determined by the size and extent of thrombus burden, and much more by the presence and extent of right ventricular dysfunction. 2 Symptomatic PE can cause death within 1 hour of onset in up to 10% of cases 3 ; it is the third largest cause of cardiovascular death after coronary artery disease and stroke, 4 occurring in up to 7% to 30% of all autopsy series. 1 Predictors of acute mortality following acute PE include: age Ͼ70 years, coexistent malignancy, heart failure, pulmonary disease, systemic hypotension, right ventricular dysfunction, and biomarkers such as cardiac troponins and B-type natriuretic peptide. [5][6][7][8] In contrast to the abundant data regarding acute outcome, predictors of long-term mortality remain poorly defined because of the rarity of large cohort studies. The few studies extending beyond 6 months have indicated an increased 1-year mortality rate after PE, which may be as high as 25%. 9 -11 Increased long-term risk of recurrent PE, cancer, and c...
