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Intermediate-High Risk Pulmonary Embolism
Limited information exists about the prevalence, management, and outcomes of intermediate-high risk patients with acute pulmonary embolism (PE). In a prospective cohort study, we evaluated consecutive patients with intermediate-high risk PE at a large, tertiary, academic medical center between Janua...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Georg Thieme Verlag KG
2019
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6892655/ https://www.ncbi.nlm.nih.gov/pubmed/31815247 http://dx.doi.org/10.1055/s-0039-3401003 |
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author | Mirambeaux, Rosa León, Francisco Bikdeli, Behnood Morillo, Raquel Barrios, Deisy Mercedes, Edwin Moores, Lisa Tapson, Victor Yusen, Roger D. Jiménez, David |
author_facet | Mirambeaux, Rosa León, Francisco Bikdeli, Behnood Morillo, Raquel Barrios, Deisy Mercedes, Edwin Moores, Lisa Tapson, Victor Yusen, Roger D. Jiménez, David |
author_sort | Mirambeaux, Rosa |
collection | PubMed |
description | Limited information exists about the prevalence, management, and outcomes of intermediate-high risk patients with acute pulmonary embolism (PE). In a prospective cohort study, we evaluated consecutive patients with intermediate-high risk PE at a large, tertiary, academic medical center between January 1, 2015 and March 31, 2019. Adjudicated outcomes included PE-related mortality and a complicated course through 30 days after initiation of PE treatment. Repeat systolic blood pressure (SBP), heart rate (HR), brain natriuretic peptide (BNP), and cardiac troponin I (cTnI) measurements, and echocardiography were performed within 48 hours after diagnosis. Among 1,015 normotensive patients with acute PE, 97 (9.6%) had intermediate-high risk PE. A 30-day complicated course and 30-day PE-related mortality occurred in 23 (24%) and 7 patients (7.2%) with intermediate-high risk PE. Seventeen (18%) intermediate-high risk patients received reperfusion therapy. Within 48 hours after initiation of anticoagulation, normalization of SBP, HR, cTnI, BNP, and echocardiography occurred in 82, 86, 78, 72, and 33% of survivors with intermediate-high risk PE who did not receive immediate thrombolysis. A complicated course between day 2 and day 30 after PE diagnosis for the patients who normalized SBP, HR, cTnI, BNP, and echocardiography measured at 48 hours occurred in 2.9, 1.4, 4.5, 3.3, and 14.3%, respectively. Intermediate-high risk PE occurs in approximately one-tenth of patients with acute symptomatic PE, and is associated with high morbidity and mortality. Normalization of HR 48 hours after diagnosis might identify a group of patients with a very low risk of deterioration during the first month of follow-up. |
format | Online Article Text |
id | pubmed-6892655 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Georg Thieme Verlag KG |
record_format | MEDLINE/PubMed |
spelling | pubmed-68926552019-12-06 Intermediate-High Risk Pulmonary Embolism Mirambeaux, Rosa León, Francisco Bikdeli, Behnood Morillo, Raquel Barrios, Deisy Mercedes, Edwin Moores, Lisa Tapson, Victor Yusen, Roger D. Jiménez, David TH Open Limited information exists about the prevalence, management, and outcomes of intermediate-high risk patients with acute pulmonary embolism (PE). In a prospective cohort study, we evaluated consecutive patients with intermediate-high risk PE at a large, tertiary, academic medical center between January 1, 2015 and March 31, 2019. Adjudicated outcomes included PE-related mortality and a complicated course through 30 days after initiation of PE treatment. Repeat systolic blood pressure (SBP), heart rate (HR), brain natriuretic peptide (BNP), and cardiac troponin I (cTnI) measurements, and echocardiography were performed within 48 hours after diagnosis. Among 1,015 normotensive patients with acute PE, 97 (9.6%) had intermediate-high risk PE. A 30-day complicated course and 30-day PE-related mortality occurred in 23 (24%) and 7 patients (7.2%) with intermediate-high risk PE. Seventeen (18%) intermediate-high risk patients received reperfusion therapy. Within 48 hours after initiation of anticoagulation, normalization of SBP, HR, cTnI, BNP, and echocardiography occurred in 82, 86, 78, 72, and 33% of survivors with intermediate-high risk PE who did not receive immediate thrombolysis. A complicated course between day 2 and day 30 after PE diagnosis for the patients who normalized SBP, HR, cTnI, BNP, and echocardiography measured at 48 hours occurred in 2.9, 1.4, 4.5, 3.3, and 14.3%, respectively. Intermediate-high risk PE occurs in approximately one-tenth of patients with acute symptomatic PE, and is associated with high morbidity and mortality. Normalization of HR 48 hours after diagnosis might identify a group of patients with a very low risk of deterioration during the first month of follow-up. Georg Thieme Verlag KG 2019-12-04 /pmc/articles/PMC6892655/ /pubmed/31815247 http://dx.doi.org/10.1055/s-0039-3401003 Text en https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Mirambeaux, Rosa León, Francisco Bikdeli, Behnood Morillo, Raquel Barrios, Deisy Mercedes, Edwin Moores, Lisa Tapson, Victor Yusen, Roger D. Jiménez, David Intermediate-High Risk Pulmonary Embolism |
title | Intermediate-High Risk Pulmonary Embolism |
title_full | Intermediate-High Risk Pulmonary Embolism |
title_fullStr | Intermediate-High Risk Pulmonary Embolism |
title_full_unstemmed | Intermediate-High Risk Pulmonary Embolism |
title_short | Intermediate-High Risk Pulmonary Embolism |
title_sort | intermediate-high risk pulmonary embolism |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6892655/ https://www.ncbi.nlm.nih.gov/pubmed/31815247 http://dx.doi.org/10.1055/s-0039-3401003 |
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