Karsten Keller1, Jürgen H Prochaska1, Meike Coldewey1, Sebastian Gobel2, Alexander Ullmann3, Claus Jünger3, Heidrun Lamparter3, Liana Ariza3, Christoph Bickel4, Michael Lauterbach5, Stavros Konstantinides1, Thomas Rostock6, Thomas Münzel7, Philipp S Wild8. 1. Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany; Department of Medicine 2, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany. 2. Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany; Department of Medicine 2, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Germany. 3. Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany. 4. Department of Medicine I, Federal Armed Forces Central Hospital Koblenz, Koblenz, Germany. 5. Department of Internal Medicine III, Hospital of Barmherzige Brüder Trier, Trier, Germany. 6. Department of Medicine 2, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany. 7. Department of Medicine 2, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany; Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Germany. 8. Center for Thrombosis and Hemostasis, Mainz, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Germany; Department of Medicine 2, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Germany; Preventive Cardiology and Preventive Medicine, University Medical Center Mainz of Johannes Gutenberg-University Mainz, Mainz, Germany. Electronic address: philipp.wild@unimedizinmainz.de.
Abstract
BACKGROUND: Pulmonary embolism (PE) is the consequence of deep vein thrombosis (DVT) in 70% of all cases. Although, PE and DVT are commonly related to risk factors of Virchow's triad, both entities are linked to cardiovascular risk factors, but risk factors seem differently important in both entities. OBJECTIVES: We aimed to investigate clinical profile and outcome of patients with PE history stratified by concomitant DVT. PATIENTS/ METHODS: Data from the observational multi-center thrombEVAL-study were analyzed. RESULTS: The sample (N=2,318) comprised 295 PE patients, of whom 69.2% (N=204) had DVT. Individuals without DVT were older and had higher prevalence of concomitant atrial fibrillation (AF), chronic lung diseases, coronary artery disease, heart failure and hypertension. Multivariable regression revealed an independent association of AF (Odds Ratio (OR) 3.17, 95% CI 1.63-6.18, P<0.001) and coronary artery disease (OR 2.31, 95% CI 1.15-4.66, P=0.019) with PE without DVT. There was higher frequency of permanent AF in individuals without DVT, whereas paroxysmal AF was more prevalent in individuals with DVT. All AF subtypes were independently associated with PE without DVT with increasing ORs from paroxysmal to permanent AF. PE patients with and without DVT did not differ in survival (P=0.32) and cost-relevant clinical outcome (P=0.26) during follow-up. AF in PE patients was associated with cost-relevant clinical outcome (Hazard Ratio (HR) 1.78, 95% CI 1.03-3.09, P=0.040), but no significant difference in survival (HR 0.93, 95% CI 0.35-2.50, P=0.88) was observed. CONCLUSIONS: History of DVT is a significant discriminator for clinical profile of PE patients. Individuals without DVT had more often cardiac and pulmonary disease with strongest association with AF. Data advocate a potential link between AF and PE. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov, Unique identifier NCT01809015.
BACKGROUND:Pulmonary embolism (PE) is the consequence of deep vein thrombosis (DVT) in 70% of all cases. Although, PE and DVT are commonly related to risk factors of Virchow's triad, both entities are linked to cardiovascular risk factors, but risk factors seem differently important in both entities. OBJECTIVES: We aimed to investigate clinical profile and outcome of patients with PE history stratified by concomitant DVT. PATIENTS/ METHODS: Data from the observational multi-center thrombEVAL-study were analyzed. RESULTS: The sample (N=2,318) comprised 295 PE patients, of whom 69.2% (N=204) had DVT. Individuals without DVT were older and had higher prevalence of concomitant atrial fibrillation (AF), chronic lung diseases, coronary artery disease, heart failure and hypertension. Multivariable regression revealed an independent association of AF (Odds Ratio (OR) 3.17, 95% CI 1.63-6.18, P<0.001) and coronary artery disease (OR 2.31, 95% CI 1.15-4.66, P=0.019) with PE without DVT. There was higher frequency of permanent AF in individuals without DVT, whereas paroxysmal AF was more prevalent in individuals with DVT. All AF subtypes were independently associated with PE without DVT with increasing ORs from paroxysmal to permanent AF. PE patients with and without DVT did not differ in survival (P=0.32) and cost-relevant clinical outcome (P=0.26) during follow-up. AF in PE patients was associated with cost-relevant clinical outcome (Hazard Ratio (HR) 1.78, 95% CI 1.03-3.09, P=0.040), but no significant difference in survival (HR 0.93, 95% CI 0.35-2.50, P=0.88) was observed. CONCLUSIONS: History of DVT is a significant discriminator for clinical profile of PE patients. Individuals without DVT had more often cardiac and pulmonary disease with strongest association with AF. Data advocate a potential link between AF and PE. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov, Unique identifier NCT01809015.
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