Thromb Haemost 2021; 121(07): 955-963
DOI: 10.1055/s-0040-1722190
Stroke, Systemic or Venous Thromboembolism

The Impact of Pulmonary Vascular Obstruction on the Risk of Recurrence of Pulmonary Embolism: A French Prospective Cohort

Charles Orione
1  Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, CIC INSERM, FCRIN INNOVTE, Brest, France
,
Cécile Tromeur
1  Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, CIC INSERM, FCRIN INNOVTE, Brest, France
,
Raphael Le Mao
1  Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, CIC INSERM, FCRIN INNOVTE, Brest, France
,
Pierre-Yves Le Floch
2  Service de radiologie, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, CIC INSERM 1412, FCRIN INNOVTE, Brest, France
,
Philippe Robin
3  Service de Médecine Nucléaire, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, GIRC Thrombose, Brest, France
,
Clément Hoffmann
4  Service d'Echo-doppler Vasculaire, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, CIC INSERM 1412, FCRIN INNOVTE, Brest, France
,
Luc Bressollette
4  Service d'Echo-doppler Vasculaire, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, CIC INSERM 1412, FCRIN INNOVTE, Brest, France
,
Michel Nonent
2  Service de radiologie, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, CIC INSERM 1412, FCRIN INNOVTE, Brest, France
,
Pierre-Yves Le Roux
3  Service de Médecine Nucléaire, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, GIRC Thrombose, Brest, France
,
Pierre-Yves Salaun
3  Service de Médecine Nucléaire, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, GIRC Thrombose, Brest, France
,
Marie Guegan
1  Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, CIC INSERM, FCRIN INNOVTE, Brest, France
5  Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, CIC INSERM 1412, FCRIN INNOVTE, Brest, France
,
Elise Poulhazan
5  Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, CIC INSERM 1412, FCRIN INNOVTE, Brest, France
,
Karine Lacut
1  Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, CIC INSERM, FCRIN INNOVTE, Brest, France
,
Christophe Leroyer
1  Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, CIC INSERM, FCRIN INNOVTE, Brest, France
,
Catherine A. Lemarié
1  Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, CIC INSERM, FCRIN INNOVTE, Brest, France
6  Département des sciences de la santé, Université de Bretagne Occidentale, UMR1078, Brest, France
,
Francis Couturaud
1  Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, CIC INSERM, FCRIN INNOVTE, Brest, France
› Author Affiliations
Funding The study was supported by grants from the “Programme Hospitalier de Recherche Clinique” (French Department of Health), the Foundation “Archipel Santé” and the sponsor was the University Hospital of Brest. The funding source was not involved in designing or conducting the study, collecting, managing, analyzing or interpreting the data, preparing, reviewing or approving the manuscript, or deciding to submit this for publication. An academic steering committee assumed overall responsibility for all these steps. Dr. Couturaud takes responsibility for data access and integrity of the data.

Abstract

Background We aimed to assess whether high pulmonary vascular obstruction index (PVOI) measured at the time of pulmonary embolism (PE) diagnosis is associated with an increased risk of recurrent venous thromboembolism (VTE).

Study Design and Methods French prospective cohort of patients with a symptomatic episode of PE diagnosed with spiral computerized tomography pulmonary angiography (CTPA) or ventilation-perfusion (V/Q) lung scan and a follow-up of at least 6 months after anticoagulation discontinuation. PVOI was assessed based on the available diagnostic exam (V/Q lung scan or CTPA). All patients had standardized follow-up and independent clinicians adjudicated all deaths and recurrent VTE events. Main outcome was recurrent VTE after stopping anticoagulation.

Results A total of 418 patients with PE were included. During a median follow-up period of 3.6 (1.2–6.0) years, 109 recurrences occurred. In multivariate analysis, PVOI ≥ 40% was an independent risk factor for recurrence (hazard ratio 1.77, 95% confidence interval 1.20–2.62, p < 0.01), whether PE was provoked by a major transient risk factor or not. A threshold at 41% was identified as the best value associated with the risk of recurrence 6 months after stopping anticoagulation (area under curve = 0.64).

Conclusion PVOI ≥ 40% at PE diagnosis was an independent risk factor for recurrence VTE. Further prospective validation studies are needed.

Authors' Contributions

F.C. had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: C.O., C.T., F.C., K.L., C.L. Acquisition of data: E.P. Statistical analysis: C.O. Analysis and interpretation of data: All. Drafting of the manuscript: C.O., F.C., C.L. Critical revision of the manuscript for important intellectual content: All. Final approval of the manuscript: All. Obtaining funding: F.C. Administrative, technical, or material support: F.C., C.T., K.L., C.L. Study supervision: F.C., C.T.


Supplementary Material



Publication History

Received: 30 August 2020

Accepted: 12 November 2020

Publication Date:
14 January 2021 (online)

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