Islam Y Elgendy1, Mohamed M Gad2, Hend Mansoor3, Ahmed N Mahmoud4, Ayman Elbadawi5, Anas Saad2, Marwan Saad6, Ahmed Elkaryoni7, Eric A Secemsky8, Mamas A Mamas9, Manuel Monreal10, Ido Weinberg11, Carl J Pepine12. 1. Division of Cardiology, Weill Cornell Medicine-Qatar, Doha, Qatar. Electronic address: iyelgendy@gmail.com. 2. Department of Medicine, Cleveland Clinic Foundation, Cleveland, OH. 3. College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar. 4. Division of Cardiology, Case Western Reserve University, School of Medicine and Harrington Heart and Vascular Institute, Cleveland, OH. 5. Department of Cardiology, University of Texas Medical Branch, Galveston, TX. 6. Division of Cardiology, The Warren Alpert School of Medicine at Brown University, Providence, RI. 7. Division of Cardiovascular Disease, Loyola University Medical Center, Loyola Stritch School of Medicine, Maywood, IL. 8. Smith Center for Outcomes Research in Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA. 9. Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom; Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom. 10. Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. 11. Division of Cardiology, Massachusetts General Hospital, Boston, MA. 12. Division of Cardiovascular Medicine, University of Florida, Gainesville, FL.
Abstract
OBJECTIVE: To investigate the trend and outcomes of acute pulmonary embolism (PE) during pregnancy and puerperium using a large national database. PATIENTS AND METHODS: The National Inpatient Sample was queried to identify pregnancy-related hospitalizations in the United States from January 1, 2007, through September 30, 2015. Temporal trends in the rates of acute PE and in-hospital mortality rates were extracted. RESULTS: Among 37,524,314 hospitalizations, 6,333 patients (0.02%) had acute PE. The prevalence of comorbidities and risk factors such as hypertension, obesity, and smoking increased, but rates of acute PE did not change significantly (18.01 in 2007 vs 19.36 in 2015, per 100,000 hospitalizations, Ptrends=.21). Advanced therapies were used in a small number of women (systemic thrombolysis: 2.4%, surgical pulmonary embolectomy: 0.5%, and inferior vena cava filter in 8.3%). Rates of in-hospital mortality were almost 200-fold higher among those who had acute PE (29.3 vs 0.13, per 1000 pregnancy-related, P<.001). The rate of in-hospital mortality did not change among women with acute PE (2.6% in 2007 vs 2.5% in 2015, Ptrends=.74). CONCLUSION: In this contemporary analysis of pregnancy-related hospitalizations, acute PE was uncommon, but rates have not decreased over the past decade. Acute PE during pregnancy and puerperium was associated with high maternal mortality, and the rates of in-hospital mortality have not improved. Future studies to improve prevention and management of acute PE during pregnancy and puerperium are warranted.
OBJECTIVE: To investigate the trend and outcomes of acute pulmonary embolism (PE) during pregnancy and puerperium using a large national database. PATIENTS AND METHODS: The National Inpatient Sample was queried to identify pregnancy-related hospitalizations in the United States from January 1, 2007, through September 30, 2015. Temporal trends in the rates of acute PE and in-hospital mortality rates were extracted. RESULTS: Among 37,524,314 hospitalizations, 6,333 patients (0.02%) had acute PE. The prevalence of comorbidities and risk factors such as hypertension, obesity, and smoking increased, but rates of acute PE did not change significantly (18.01 in 2007 vs 19.36 in 2015, per 100,000 hospitalizations, Ptrends=.21). Advanced therapies were used in a small number of women (systemic thrombolysis: 2.4%, surgical pulmonary embolectomy: 0.5%, and inferior vena cava filter in 8.3%). Rates of in-hospital mortality were almost 200-fold higher among those who had acute PE (29.3 vs 0.13, per 1000 pregnancy-related, P<.001). The rate of in-hospital mortality did not change among women with acute PE (2.6% in 2007 vs 2.5% in 2015, Ptrends=.74). CONCLUSION: In this contemporary analysis of pregnancy-related hospitalizations, acute PE was uncommon, but rates have not decreased over the past decade. Acute PE during pregnancy and puerperium was associated with high maternal mortality, and the rates of in-hospital mortality have not improved. Future studies to improve prevention and management of acute PE during pregnancy and puerperium are warranted.