Clinical Predictors for Fatal Pulmonary Embolism in 15 520 Patients With Venous Thromboembolism
Copyright policy )Clinical Predictors for Fatal Pulmonary Embolism in 15 520 Patients With Venous Thromboembolism
Background— Clinical predictors for fatal pulmonary embolism (PE) in patients with venous thromboembolism have never been studied. Methods and Results— Using data from the international prospective Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) registry about patients with objectively confirmed symptomatic acute venous thromboembolism, we determined independent predictive factors for fatal PE. Between March 2001 and July 2006, 15 520 consecutive patients (mean age±SD, 66.3±16.9 years; 49.7% men) with acute venous thromboembolism were included. Symptomatic deep-vein thrombosis without symptomatic PE was observed in 58.0% (n=9008) of patients, symptomatic nonmassive PE in 40.4% (n=6264), and symptomatic massive PE in 1.6% (n=248). At 3 months, the cumulative rates of overall mortality and fatal PE were 8.65% and 1.68%, respectively. On multivariable analysis, patients with symptomatic nonmassive PE at presentation exhibited a 5.42-fold higher risk of fatal PE compared with patients with deep-vein thrombosis without symptomatic PE ( P <0.001). The risk of fatal PE was multiplied by 17.5 in patients presenting with a symptomatic massive PE. Other clinical factors independently associated with an increased risk of fatal PE were immobilization for neurological disease, age >75 years, and cancer. Conclusion— PE remains a potentially fatal disease. The clinical predictors identified in the present study should be included in any clinical risk stratification scheme to optimally adapt the treatment of PE to the risk of the fatal outcome.
MESH: Pulmonary Embolism, Male, pulmonary embolism, Internationality, MESH: Registries, Medical Subject Headings::Named Groups::Persons::Age Groups::Adult::Aged::Aged, 80 and over, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Follow-Up Studies, Medical Subject Headings::Geographicals::Geographic Locations::Europe::Spain, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Prospective Studies, Cohort Studies, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Research Design::Sensitivity and Specificity::Predictive Value of Tests, MESH: Risk Factors, Risk Factors, 80 and over, Prospective Studies, Registries, MESH: Cohort Studies, death, sudden, MESH: Aged, Aged, 80 and over, Venous Thrombosis, MESH: Middle Aged, MESH: Follow-Up Studies, Middle Aged, MESH: Predictive Value of Tests, Medical Subject Headings::Check Tags::Male, Medical Subject Headings::Disciplines and Occupations::Social Sciences::Internationality, Female, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Registries, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Risk::Risk Factors, 610, Medical Subject Headings::Named Groups::Persons::Age Groups::Adult::Aged, Predictive Value of Tests, 616, MESH: Spain, Humans, thrombosis, Aged, MESH: Humans, Medical Subject Headings::Check Tags::Female, Medical Subject Headings::Diseases::Cardiovascular Diseases::Vascular Diseases::Embolism and Thrombosis::Thrombosis::Venous Thrombosis, MESH: Prospective Studies, MESH: Male, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies, Spain, MESH: Venous Thrombosis, MESH: Internationality, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, prognosis, Pulmonary Embolism, MESH: Female, Follow-Up Studies
MESH: Pulmonary Embolism, Male, pulmonary embolism, Internationality, MESH: Registries, Medical Subject Headings::Named Groups::Persons::Age Groups::Adult::Aged::Aged, 80 and over, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Follow-Up Studies, Medical Subject Headings::Geographicals::Geographic Locations::Europe::Spain, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Prospective Studies, Cohort Studies, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Research Design::Sensitivity and Specificity::Predictive Value of Tests, MESH: Risk Factors, Risk Factors, 80 and over, Prospective Studies, Registries, MESH: Cohort Studies, death, sudden, MESH: Aged, Aged, 80 and over, Venous Thrombosis, MESH: Middle Aged, MESH: Follow-Up Studies, Middle Aged, MESH: Predictive Value of Tests, Medical Subject Headings::Check Tags::Male, Medical Subject Headings::Disciplines and Occupations::Social Sciences::Internationality, Female, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Registries, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Risk::Risk Factors, 610, Medical Subject Headings::Named Groups::Persons::Age Groups::Adult::Aged, Predictive Value of Tests, 616, MESH: Spain, Humans, thrombosis, Aged, MESH: Humans, Medical Subject Headings::Check Tags::Female, Medical Subject Headings::Diseases::Cardiovascular Diseases::Vascular Diseases::Embolism and Thrombosis::Thrombosis::Venous Thrombosis, MESH: Prospective Studies, MESH: Male, Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies, Spain, MESH: Venous Thrombosis, MESH: Internationality, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, prognosis, Pulmonary Embolism, MESH: Female, Follow-Up Studies
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