Maria Cristina Vedovati1, Cecilia Becattini2, Giancarlo Agnelli2, Pieter W Kamphuisen3, Luca Masotti4, Piotr Pruszczyk5, Franco Casazza6, Aldo Salvi7, Stefano Grifoni8, Anna Carugati9, Stavros Konstantinides10, Marthe Schreuder3, Marek Golebiowski11, Michele Duranti12. 1. Internal and Cardiovascular Medicine-Stroke Unit, S Maria della Misericordia Hospital, Perugia, Italy. Electronic address: mcristinaved@yahoo.it. 2. Internal and Cardiovascular Medicine-Stroke Unit, S Maria della Misericordia Hospital, Perugia, Italy. 3. Department of Vascular Medicine, University Medical Center Groningen, Groningen, The Netherlands. 4. Department of Internal Medicine, Cecina Hospital, Cecina, Italy. 5. Department of Internal Medicine and Cardiology, Warsaw, Poland. 6. Department of Cardiology, San Carlo Borromeo Hospital, Milan, Italy. 7. Department of Emergency Medicine, Ancona Hospital, Ancona, Italy. 8. Department of Emergency Medicine, Careggi Hospital, Florence, Italy. 9. Department of Internal Medicine, Valduce Hospital, Como, Italy. 10. Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece. 11. Department of Radiology, Warsaw Medical University, Warsaw, Poland. 12. University of Perugia, and Department of Radiology, S Maria della Misericordia Hospital, Perugia, Italy.
Abstract
BACKGROUND: In patients with acute pulmonary embolism (PE), the correlation between the embolic burden assessed by multidetector CT (MDCT) scan and clinical outcomes remains unclear. Patients with symptomatic acute PE diagnosed based on MDCT angiography were included in a multicenter study aimed at assessing the prognostic role of the embolic burden evaluated with MDCT scan. METHODS: Embolic burden was assessed as (1) localization of the emboli as central (saddle or at least one main pulmonary artery), lobar, or distal (segmental or subsegmental arteries) and (2) the obstruction index by the scoring system of Qanadli. The primary outcome was 30-day all-cause death or clinical deterioration. Predictors of all-cause death or clinical deterioration were identified by Cox regression statistics. RESULTS: Overall, 579 patients were included in the study; 60 (10.4%) died or had clinical deterioration at 30 days. Central localization of emboli was not associated with all-cause death or clinical deterioration (hazard ratio [HR], 2.42; 95% CI, 0.77-7.59; P 5 .13). However, in 516 hemodynamically stable patients, central localization of emboli (HR, 8.3; 95% CI, 1.0-67; P 5 .047) was an independent predictor of all-cause death or clinical deterioration, whereas distal emboli were inversely associated with these outcome events (HR, 0.12; 95% CI, 0.015-0.97; P 5 .047). No correlation was found between obstruction index (evaluated in 448 patients) and all-cause death or clinical deterioration in the overall study population and in the hemodynamically stable patients. CONCLUSIONS: In hemodynamically stable patients with acute PE, central emboli are associated with an increased risk for all-cause death or clinical deterioration. This risk is low in patients with segmental or subsegmental PE.
BACKGROUND: In patients with acute pulmonary embolism (PE), the correlation between the embolic burden assessed by multidetector CT (MDCT) scan and clinical outcomes remains unclear. Patients with symptomatic acute PE diagnosed based on MDCT angiography were included in a multicenter study aimed at assessing the prognostic role of the embolic burden evaluated with MDCT scan. METHODS:Embolic burden was assessed as (1) localization of the emboli as central (saddle or at least one main pulmonary artery), lobar, or distal (segmental or subsegmental arteries) and (2) the obstruction index by the scoring system of Qanadli. The primary outcome was 30-day all-cause death or clinical deterioration. Predictors of all-cause death or clinical deterioration were identified by Cox regression statistics. RESULTS: Overall, 579 patients were included in the study; 60 (10.4%) died or had clinical deterioration at 30 days. Central localization of emboli was not associated with all-cause death or clinical deterioration (hazard ratio [HR], 2.42; 95% CI, 0.77-7.59; P 5 .13). However, in 516 hemodynamically stable patients, central localization of emboli (HR, 8.3; 95% CI, 1.0-67; P 5 .047) was an independent predictor of all-cause death or clinical deterioration, whereas distal emboli were inversely associated with these outcome events (HR, 0.12; 95% CI, 0.015-0.97; P 5 .047). No correlation was found between obstruction index (evaluated in 448 patients) and all-cause death or clinical deterioration in the overall study population and in the hemodynamically stable patients. CONCLUSIONS: In hemodynamically stable patients with acute PE, central emboli are associated with an increased risk for all-cause death or clinical deterioration. This risk is low in patients with segmental or subsegmental PE.
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