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Open Access
CC BY 4.0 · TH Open 2019; 03(04): e356-e363
DOI: 10.1055/s-0039-3401003
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Intermediate-High Risk Pulmonary Embolism

Authors

  • Rosa Mirambeaux‡   *

    1   Respiratory Department, Ramon y Cajal Hospital, Madrid, Spain

  • Francisco León‡   *

    1   Respiratory Department, Ramon y Cajal Hospital, Madrid, Spain

  • Behnood Bikdeli

    2   Division of Cardiology, Department of Medicine, Columbia University Medical Center, NewYork–Presbyterian Hospital, New York, New York, United States
    3   Center for Outcomes Research and Evaluation (CORE), Yale University School of Medicine, New Haven, Connecticut, United States
    4   Cardiovascular Research Foundation (CRF), New York, New York, United States

  • Raquel Morillo

    1   Respiratory Department, Ramon y Cajal Hospital, Madrid, Spain

  • Deisy Barrios

    1   Respiratory Department, Ramon y Cajal Hospital, Madrid, Spain

  • Edwin Mercedes

    1   Respiratory Department, Ramon y Cajal Hospital, Madrid, Spain

  • Lisa Moores

    5   F. Edward Hebert School of Medicine, Uniformed Services University, Bethesda, Maryland, United States

  • Victor Tapson

    6   Pulmonary/Critical Care Division, Cedars-Sinai Medical Center, Los Angeles, California, United States

  • Roger D. Yusen

    7   Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri, United States

  • David Jiménez

    1   Respiratory Department, Ramon y Cajal Hospital, Madrid, Spain
    8   Medicine Department, Universidad de Alcala, Madrid, Spain
    9   CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain

Funding This work has been supported in part by a grant NEUMOMADRID 2016 and SEPAR 512/2017.
Further Information

Publication History

01 August 2019

28 October 2019

Publication Date:
04 December 2019 (online)

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Abstract

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.

Keywords

pulmonary embolism - intermediate-high risk - survival - prognosis

Authors' Contributions

Study concept and design: R.M., B.B., D.J.

Acquisition of data; analysis and interpretation of data; statistical analysis: R.M., F.L., B.B., R.M., D.B., E.M., L.M., V.T., R.D.Y., D.J.

Critical revision of the manuscript for important intellectual content: R.M., F.L., B.B., R.M., D.B., E.M., L.M., V.T., R.D.Y., D.J.

Study supervision: B.B., D.J.

D.J. has full access to all the data in the study and takes the final responsibility of the decision of submitting the manuscript for publication.


* These authors contributed equally to the manuscript.


Supplementary Material