Clinical course and prognosis of acute pulmonary embolism
- 90 Downloads
Effective treatment of acute pulmonary embolism (PE) requires prompt identification of patients at high risk of death or severe cardiovascular complications during the hospital stay. Determination of prognostic parameters in this heterogeneous patient population is far more important than calculation of a crude mortality rate due to PE. The multicenter Management Strategy and Prognosis in Pulmonary Embolism Registry examined the in-hospital clinical course of 1001 consecutive patients with acute PE. Overall mortality was 22 %, with 91 % of deaths directly related to PE. Clinical signs of acute right heart failure due to major PE (arterial hypotension, shock, circulatory collapse) were clearly associated with an adverse outcome. Mortality ranged from 8 to 65 % depending on the severity of clinical instability at presentation. Importantly, a significantly increased death rate was also observed in patients with echocardiographi-cally detected right ventricular dilation (84 vs. 16 %), a reliable noninvasive index of impending right heart failure. The independent prognostic effect of this finding was confirmed by multivariate analysis (Odds Ratio, 2.44; P = 0.004). Thus, the combination of clinical and echocardiographic findings permits accurate risk stratification of patients with acute PE. Evidence is also accumulating that these prognostic factors can be used to identify candidates for early thombolytic treatment.
Key wordsPulmonary embolism echocardiography prognosis mortality thrombolysis
Unable to display preview. Download preview PDF.
- 4.Dalla-Volta S, Palla A, Santolicandro A, Giuntini C, Pengo V, Visioli O, Zonzin P, Zanuttini D, Barbaresi F, Agnelli G, Morpurgo M, Marini MG, Visani L (1992) PAIMS 2: Alteplase combined with heparin versus heparin in the treatment of acute pulmonary embolism. Plasminogen Activator Italian Multicenter Study 2. J Am Coll Cardiol 20:520–526PubMedCrossRefGoogle Scholar
- 6.Goldhaber SZ, Haire WD, Feldstein ML, Miller M, Toltzis R, Smith JL, Taveira da Silva AM, Come PC, Lee RT, Parker JA, Mogtader A, McDonough TJ, Braunwald E (1993) Alteplase versus heparin in acute pulmonary embolism: Randomised trial assessing right-ventricular function and pulmonary perfusion. Lancet 341: 507–511PubMedCrossRefGoogle Scholar
- 14.Konstantinides S, Geibel A, Olschewski M, Heinrich F, Grosser KD, Rauber K, Iversen S, Redecker M, Kienast J, Just H, Kasper W (1997) Association between thrombolytic treatment and the prognosis of hemody-namically stable patients with major pulmonary embolism: Results of a multicenter registry. Circulation 96:882–888PubMedGoogle Scholar
- 19.Research Committee of the British Thoracic Society (1992) Optimum duration of anticoagulation for deep-vein thrombosis and pulmonary embolism. Lancet 340:873–876Google Scholar
- 23.Verstraete M(1995) Thrombolytic treatment. Br Med J 311:582–583Google Scholar