Shushi Nishiwaki1, Yusuke Morita2, Yugo Yamashita3, Takeshi Morimoto4, Hidewo Amano5, Toru Takase6, Seiichi Hiramori7, Kitae Kim8, Maki Oi9, Masaharu Akao10, Yohei Kobayashi11, Mamoru Toyofuku12, Toshiaki Izumi1, Tomohisa Tada13, Po-Min Chen14, Koichiro Murata15, Yoshiaki Tsuyuki16, Syunsuke Saga17, Tomoki Sasa18, Jiro Sakamoto19, Minako Kinoshita20, Kiyonori Togi21, Hiroshi Mabuchi22, Kensuke Takabayashi23, Hiroki Shiomi3, Takao Kato3, Takeru Makiyama3, Koh Ono3, Moriaki Inoko1, Takeshi Kimura3. 1. Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan. 2. Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan. Electronic address: ysmorita2@gmail.com. 3. Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 4. Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan. 5. Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan. 6. Department of Cardiology, Kinki University Hospital, Osaka, Japan. 7. Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan. 8. Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan. 9. Department of Cardiology, Japanese Red Cross Otsu Hospital, Otsu, Japan. 10. Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan. 11. Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan. 12. Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan. 13. Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan. 14. Department of Cardiology, Osaka Saiseikai Noe Hospital, Osaka, Japan. 15. Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan. 16. Division of Cardiology, Shimada Municipal Hospital, Shimada, Japan. 17. Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan. 18. Department of Cardiology, Kishiwada City Hospital, Kishiwada, Japan. 19. Department of Cardiology, Tenri Hospital, Tenri, Japan. 20. Department of Cardiology, Nishikobe Medical Center, Kobe, Japan. 21. Division of Cardiology, Nara Hospital, Kinki University Faculty of Medicine, Ikoma, Japan. 22. Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan. 23. Department of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan.
Abstract
BACKGROUND: The majority of acute pulmonary embolism (PE) is caused by thrombus developed from leg veins. However, impact of concomitant deep venous thrombosis (DVT) on clinical outcomes has not been fully evaluated in patients with acute PE. METHODS: The COMMAND VTE Registry is a multicenter registry enrolling consecutive 3027 patients with acute symptomatic venous thromboembolism (VTE) in Japan. The current study population consisted of 655 acute PE patients who underwent lower extremities ultrasound examination at diagnosis for the assessment of concomitant DVT status. RESULTS: There were 424 patients with proximal DVT (64.7%), 162 patients with distal DVT (24.7%), and 69 patients with no DVT (10.5%). The cumulative 90-day incidence of all-cause death was higher in proximal DVT patients than in distal DVT and no DVT patients (7.9%, 2.5%, and 1.4%, p = 0.01). Regarding the causes of death, the cumulative 90-day incidence of PE-related death was low, and not significantly different across the 3 groups (1.4%, 0.6%, and 1.7%, p = 0.62). The most frequent cause of death was cancer in proximal and distal DVT patients. There were no significant differences in 90-day rates of recurrent VTE and major bleeding, regardless of the status of concomitant DVT (2.9%, 3.2%, and 2.2%, p = 0.79, and 1.5%, 4.4%, and 4.9%, p = 0.46, respectively). CONCLUSIONS: Acute PE with proximal DVT at diagnosis was associated with a higher risk for short-term mortality than in patients without DVT, while the risk for short-term mortality was not significantly different between distal DVT patients and patients without DVT.
BACKGROUND: The majority of acute pulmonary embolism (PE) is caused by thrombus developed from leg veins. However, impact of concomitant deep venous thrombosis (DVT) on clinical outcomes has not been fully evaluated in patients with acute PE. METHODS: The COMMAND VTE Registry is a multicenter registry enrolling consecutive 3027 patients with acute symptomatic venous thromboembolism (VTE) in Japan. The current study population consisted of 655 acute PE patients who underwent lower extremities ultrasound examination at diagnosis for the assessment of concomitant DVT status. RESULTS: There were 424 patients with proximal DVT (64.7%), 162 patients with distal DVT (24.7%), and 69 patients with no DVT (10.5%). The cumulative 90-day incidence of all-cause death was higher in proximal DVT patients than in distal DVT and no DVT patients (7.9%, 2.5%, and 1.4%, p = 0.01). Regarding the causes of death, the cumulative 90-day incidence of PE-related death was low, and not significantly different across the 3 groups (1.4%, 0.6%, and 1.7%, p = 0.62). The most frequent cause of death was cancer in proximal and distal DVT patients. There were no significant differences in 90-day rates of recurrent VTE and major bleeding, regardless of the status of concomitant DVT (2.9%, 3.2%, and 2.2%, p = 0.79, and 1.5%, 4.4%, and 4.9%, p = 0.46, respectively). CONCLUSIONS: Acute PE with proximal DVT at diagnosis was associated with a higher risk for short-term mortality than in patients without DVT, while the risk for short-term mortality was not significantly different between distal DVT patients and patients without DVT.