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The value of distinguishing patients with isolated subsegmental pulmonary embolism presenting to two tertiary hospitals in Australia: an observational study

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Abstract

Isolated-subsegmental-pulmonary-embolism (SSPE) is increasingly diagnosed with the use of computed-tomography-pulmonary-angiogram (CTPA). There remains clinical equipoise for management of SSPE with previous studies not accounting for frailty while determining clinical outcomes. Clinical outcomes among patients with isolated SSPE were compared with those with a more proximal PE after accounting for frailty and other risk-factors. This study included all patients with a positive CTPA for pulmonary embolism (PE) admitted between 2017 and 2021 to two Australian-tertiary-hospitals. Frailty was determined by use of the hospital-frailty-risk-score (HFRS). Competing-risk-analysis and Cox-proportional hazard models determined the cumulative-risk of VTE and mortality within 3 months and 1 year of index PE event after adjustment for frailty and other variables. Of 334 patients with positive CTPA for PE, 111 (33.2%) had isolated-SSPE. The mean (SD) age was 64.3 (17.7) years, 50.9% were males and 9.6% were frail. The risk of recurrent VTE within 3-months (0.9% vs. 1.8%, P = 0.458) and within 1-year of follow-up (2.7% vs. 6.3%, P = 0.126) did not differ significantly between patients with isolated SSPE and those with more proximal PE. After adjusted analyses, the cumulative-incidence of recurrent VTE was not different among patients with isolated SSPE within 1 year of index event [subdistribution-hazard-ratio (HR) 0.84, 95% CI 0.19 to 3.60]. Similarly, mortality within 1 year of index event was also not different between the two groups (aHR 1.72, 95% CI 0.92–3.23). The prevalence of SSPE was 33.2% and even after adjustment for frailty these patients had no different clinical outcomes than those with proximal PE.

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Data availability

Data used for this research are available from the authors on reasonable request and if permitted by the ethics committee.

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The authors did not receive support from any organisation for the submitted work.

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Authors and Affiliations

  1. College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia

    Yogesh Sharma & Rashmi Shahi

  2. Department of General Medicine, Division of Medicine, Cardiac & Critical Care, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5002, Australia

    Yogesh Sharma & Subodha Sumanadasa

  3. Department of Clinical Epidemiology, Flinders Medical Centre, Adelaide, SA, Australia

    Chris Horwood

  4. Discipline of Medicine, The University of Adelaide, Adelaide, SA, Australia

    Campbell Thompson

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  1. Yogesh Sharma
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Contributions

All authors have read and approved this manuscript for submission. YS conceived and designed this study. SS, RS and CH were involved in data collection. YS, SS, RS, CH, and CT contributed to analysis, interpretation, writing, and revising of the manuscript including final approval.

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Correspondence to Yogesh Sharma.

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Sharma, Y., Sumanadasa, S., Shahi, R. et al. The value of distinguishing patients with isolated subsegmental pulmonary embolism presenting to two tertiary hospitals in Australia: an observational study. J Thromb Thrombolysis 56, 215–225 (2023). https://doi.org/10.1007/s11239-023-02845-3

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