Epidemiology, patterns of care and mortality for patients with hemodynamically unstable acute symptomatic pulmonary embolism

Jiménez, David; Bikdeli, Behnood; Barrios, Deisy; Quezada, Andrés; Toro, J. del; Vidal, G.; Mahé, Isabelle; Quéré, I.; Loring, Mónica; Yusen, Roger D.; Monreal, Manuel

doi:10.1016/j.ijcard.2018.07.059

Cited by 44 publications

(23 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Most bleeding events occurred in the days after the diagnosis of PE, and have been shown to be related to the use of thrombolysis, which increases bleeding 2.3 times. 5 Such findings are coherent with previous data. 11…”

Section: Analyses Stratified By Cancer Statussupporting

confidence: 91%

“…Little is known on the long‐term prognosis of patients after a massive PE. In the short term (in‐hospital and up to 3 months), prior studies indicate a poorer overall prognosis in those with severity factors such as systolic arterial hypotension and right ventricular (RV) hypokinesis, 3,4 with most short‐term deaths due to PE 5 . Longer term data are limited to a monocentric French retrospective cohort of massive and sub‐massive PE treated with thrombolysis in the 1990s suggesting a mortality of 30% at 5 years and a recurrent PE in 12% among short‐term survivors 6 .…”

Section: Introductionmentioning

confidence: 99%

“…In the short term (in-hospital and up to 3 months), prior studies indicate a poorer overall prognosis in those with severity factors such as systolic arterial hypotension and right ventricular (RV) hypokinesis, 3,4 with most short-term deaths due to PE. 5 Longer term data are limited to a monocentric French retrospective cohort of massive and sub-massive PE treated with thrombolysis in the 1990s suggesting a mortality of 30% at 5 years and a recurrent PE in 12% among short-term survivors. 6 However, the clinical management of patients following massive PE, with regard to the duration of anticoagulation, intimately relates to the risk of recurrent VTE and of the severity of recurrent events, and such data are lacking.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comparative clinical prognosis of massive and non‐massive pulmonary embolism: A registry‐based cohort study

Blondon¹,

Jiménez

Robert‐Ebadi³

et al. 2021

Journal of Thrombosis and Haemostasis

Self Cite

View full text Add to dashboard Cite

Aims: Little is known about the prognosis of patients with massive pulmonary embolism (PE) and its risk of recurrent venous thromboembolism (VTE) compared with non-massive PE, which may inform clinical decisions. Our aim was to compare the risk of recurrent VTE, bleeding, and mortality after massive and non-massive PE during anticoagulation and after its discontinuation. Methods and results: We included all participants in the RIETE registry who suffered a symptomatic, objectively confirmed segmental or more central PE. Massive PE was defined by a systolic hypotension at clinical presentation (<90 mm Hg). We compared the risks of recurrent VTE, major bleeding, and mortality using time-toevent multivariable competing risk modeling. There were 3.5% of massive PE among 38 996 patients with PE. During the anticoagulation period, massive PE was associated with a greater risk of major bleeding (subhazard ratio [sHR] 1.72, 95% confidence interval [CI] 1.28-2.32), but not of recurrent VTE (sHR 1.15, 95% CI 0.75-1.74) than non-massive PE. An increased risk of mortality was only observed in the first month after PE. After discontinuation of anticoagulation, among 11 579 patients, massive PE and non-massive PE had similar risks of mortality, bleeding, and recurrent VTE (sHR 0.85, 95% CI 0.51-1.40), but with different case fatality of recurrent PE (11.1% versus 2.4%, P = .03) and possibly different risk of recurrent fatal PE (sHR 3.65, 95% CI 0.82-16.24). Conclusion: In this large prospective registry, the baseline hemodynamic status of the incident PE did not influence the risk of recurrent VTE, during and after the anticoagulation periods, but was possibly associated with recurrent PE of greater severity.

show abstract

Section: Analyses Stratified By Cancer Statussupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparative clinical prognosis of massive and non‐massive pulmonary embolism: A registry‐based cohort study

Blondon¹,

Jiménez

Robert‐Ebadi³

et al. 2021

Journal of Thrombosis and Haemostasis

Self Cite

View full text Add to dashboard Cite

show abstract

“…Hemodynamically unstable acute pulmonary embolism (PE) is a cardiovascular emergency, associated with high risk of death from worsening right ventricle (RV) failure and cardiogenic/obstructive shock, with an in-hospital mortality rate of > 15%. 1 2 3 For normotensive patients diagnosed with PE, risk stratification should aim to identify the group of patients deemed as having a high risk for a PE-related complicated course (intermediate-high risk PE) that might benefit from intensive monitoring or escalation of therapy. 4…”

Section: Introductionmentioning

confidence: 99%

Intermediate-High Risk Pulmonary Embolism

Mirambeaux

León

Bikdeli

et al. 2019

TH Open

Self Cite

View full text Add to dashboard Cite

Limited information exists about the prevalence, management, and outcomes of intermediate-high risk patients with acute pulmonary embolism (PE). In a prospective cohort study, we evaluated consecutive patients with intermediate-high risk PE at a large, tertiary, academic medical center between January 1, 2015 and March 31, 2019. Adjudicated outcomes included PE-related mortality and a complicated course through 30 days after initiation of PE treatment. Repeat systolic blood pressure (SBP), heart rate (HR), brain natriuretic peptide (BNP), and cardiac troponin I (cTnI) measurements, and echocardiography were performed within 48 hours after diagnosis. Among 1,015 normotensive patients with acute PE, 97 (9.6%) had intermediate-high risk PE. A 30-day complicated course and 30-day PE-related mortality occurred in 23 (24%) and 7 patients (7.2%) with intermediate-high risk PE. Seventeen (18%) intermediate-high risk patients received reperfusion therapy. Within 48 hours after initiation of anticoagulation, normalization of SBP, HR, cTnI, BNP, and echocardiography occurred in 82, 86, 78, 72, and 33% of survivors with intermediate-high risk PE who did not receive immediate thrombolysis. A complicated course between day 2 and day 30 after PE diagnosis for the patients who normalized SBP, HR, cTnI, BNP, and echocardiography measured at 48 hours occurred in 2.9, 1.4, 4.5, 3.3, and 14.3%, respectively. Intermediate-high risk PE occurs in approximately one-tenth of patients with acute symptomatic PE, and is associated with high morbidity and mortality. Normalization of HR 48 hours after diagnosis might identify a group of patients with a very low risk of deterioration during the first month of follow-up.

show abstract

“…В регистре REITE (2008) риск неблагоприятного исхода был также ассоциирован с возрастом (старше 75 лет) и, кроме этого, с массивным характером ТЭЛА и/или ЗНО [15]. В более поздних работах к факторам риска неблагоприятного прогноза были отнесены гипокинезия правого желудочка (ПЖ) (отношение шансов (ОШ) 5,59), наличие тромбов в правых отделах сердца (ОШ 8,51) [16] и нестабильная гемодинамика (наблюдается у 3,5% больных с ТЭЛА; 30-дневная летальность у них составляет 14% против 5,4% у гемодинамически стабильных больных, p<0,001) [24].…”

unclassified

Epidemiology of pulmonary embolism in today’s context: analysis of incidence, mortality and problems of their study

Никулина

Тереховская

2019

Russ J Cardiol

View full text Add to dashboard Cite

Тромбоэмболия легочной артерии (ТЭЛА) является третьим по распространенности сердечно-сосудистым заболеванием (расчетная заболеваемость в Европе и США составляет не менее 250-300 тыс. в год), а также одной из основных причин смертности. При этом, за последние два десятилетия регистрируется неуклонный рост заболеваемости ТЭЛА при относительно стабильной распространенности тромбоза глубоких вен. Получение объективной эпидемиологической и статистической информации по ТЭЛА затруднено, что связано с трудностями диагностики (неспецифич ностью клинических симптомов, поздней обращаемостью, ограничением диагностических возможностей, частотой проведения аутопсий, недостаточной настороженностью врачей) и особенностями статистического учета (являясь осложнением других заболеваний, ТЭЛА подлежит учету только при мультикаузальном статистическом анализе диагноза, что не является широко распространенной практикой; в Международной статистической классификации болезней и проблем, связанных со здоровьем, 10-го пересмотра-рубрика I26 "Легочная эмболия" включает в себя также иные состояния и исключает ТЭЛА вследствие акушерско-гинекологической патологии, поэтому "вычленить" ТЭЛА как единую нозологическую единицу в официальных статистических отчетах при существующей системе ее кодирования не представляется возможным).

show abstract

Epidemiology, patterns of care and mortality for patients with hemodynamically unstable acute symptomatic pulmonary embolism

Cited by 44 publications

References 27 publications

Comparative clinical prognosis of massive and non‐massive pulmonary embolism: A registry‐based cohort study

Comparative clinical prognosis of massive and non‐massive pulmonary embolism: A registry‐based cohort study

Intermediate-High Risk Pulmonary Embolism

Epidemiology of pulmonary embolism in today’s context: analysis of incidence, mortality and problems of their study

Contact Info

Product

Resources

About