P3501Association between elevated baseline blood urea nitrogen and mortality in patients with acute pulmonary embolism

Abstract

738 Acute pulmonary embolism: initial management version (PESI, sPESI) was performed in all pts. Qanadli score (QS) was used as the MDCT measure of thrombotic burden in the pulmonary arteries (PA). Results: The IHR and HR status were noted in 75 and 17 pts of UFT group, and in 22 and 4 pts of RT group, respectively. Clinical, echo and MDCT measures and median time delay from symptoms to treatment were comparable between UFT and RT groups (p>0.05). Failure in the placement of catheter was experienced in 1 out of 27 RT attempts, but in none of the UFT practices. Tissue-plasminogen activator (t-PA) dosage were 35,5±16,3 mg and treatment duration was 23,6±7,9 hours in UFT arm whereas adjuvant t-PA (14,6±5,1mg) was required in only 5 pts (19,2%) treated with RT. Regardless of the risk status, both UFT and RT resulted in dramatic improvements in tricuspid annular planary systolic excursion (mm) and tissue velocity (cm/sec), PA systolic and mean pressures (mmHg), QS, right to left ventricle and atrial diameter ratios (RV/LV, RA/LA) and diameters of main, right and left PA (mm) (p<0.001 for all). Death was documented in 5 pts (5,4%) in UFT and 2 pts (7.6%) in RT groups. Non-fatal major bleeding was not observed. The RT induced a short-term sinus bradicardia or conduction disturbances during system activation periods and a post-procedural gross hemoglobinuria in all pts. A left main coronary artery dissection needing stent implantation occurred in one pt immediately after RT. Post-discharge PE-related morbidity and mortality was not documented during median follow-up of 24,2 (1-54) months. Conclusions: Irrespective of the risk status, both UFT and RT facilitate thrombolysis, stabilisation of pulmonary hemodynamics and right heart functions with low rates of complications in pts with PE. Background/Introduction: Treatment of pulmonary embolism (PE) has evolved over the past decade. Current guidelines underline the importance of risk stratification to identify patients with high risk for an adverse outcome and to guide treatment decisions. However, real world data on the impact of these advances on patient outcome are limited. Purpose: To evaluate temporal trends in risk-adjusted management and outcome of patients with acute PE. Methods: Consecutive patients with confirmed PE enrolled in a prospective on-going single centre registry between September 2008 and August 2016 were studied. We evaluated temporal trends in acute revascularisation (systemic thrombolysis, surgical thrombectomy and interventional approaches), in-hospital adverse outcome (intubation, treatment with catecholamines, resuscitation or PErelated death), in-hospital and one year all-cause mortality and length of hospital stay. Results: We analysed 605 patients (median age 70 years [IQR, years, 53% female) with a high percentage of patients classified as high-and intermediate-high-risk (8.8% and 26.6%, respectively) according to the ESC 2014 risk stratification algorithm. Acute revascularisation was performed in 9.4% with a stable rate throughout the study ...