Association of risk stratification and mortality outcomes in patients of acute pulmonary embolism

Abstract

Background: To study the association of risk stratification and mortality outcomes of patients with high/intermediate risk acute pulmonary embolism who are given the guideline directed therapy after the diagnosis of pulmonary embolism.Methods: Prospective observational study of demographics, clinical profile, risk stratification, management and outcome of patients presenting with acute pulmonary embolism from October 2019to December 2020. Risk stratification was done as per ESC 2019 guidelines into high and intermediate categories, intermediate category patients were further stratified into intermediate-high and intermediate-low-risks.Results: 100 patients who were detected to have acute pulmonary thromboembolism with a mean age of 45.08 years with 60% being males were included in the study. There were 31 patients in high-risk group, 59 patients in intermediate-high subgroup, 10 patients in intermediate-low subgroup. Echocardiography was done in all patients. Outcome was relatively grave in these subgroups with overall mortality of 56 patients. 49 patients were thrombolysed with rTPA, 27patients with alteplase, 4 patients with streptokinase, 12patients who had contraindication to systemic thrombolysis were subjected to catheter directed thrombolysis and 8 patients were taken up for surgical embolectomy.Conclusions: Pulmonary embolism can present with unexplained dyspnea and atypical chest pain among other signs and symptoms. Early diagnosis, risk stratification and guideline directed prompt management can lead to favorable outcomes however; patients with high and intermediate risk at presentation are associated with higher mortality rate despite GDT.