Author + information
- Ami Patel,
- Kinan Kassar,
- Manik Veer,
- Mark Doyle and
- Manreet Kanwar
Acute pulmonary embolism (PE) continues to be a leading cause of hospital admission with significant associated short and long term adverse events, including mortality. The PESI (Pulmonary Embolism Severity Index) score is a well known prognostic model derived to risk stratifies patients presenting with acute PE. However, the score often does not optimally correlate with short term clinical outcomes. This study was sought to explore the prognostic value of various radiological and clinical parameters, in predicting short term mortality in patients with acute PE.
264 patients with a diagnosis of acute PE from February - December 2016 at Allegheny General Hospital were included in this retrospective study. Data collected included demographics, medical co morbidities, labs and radiological assessments including clot burden and RV/LV ratio, calculated PESI scores, length of stay and clinical outcomes (including mortality) during their index hospitalization.
Over the 11-month period, 264 patients presented with an acute PE. The mean age was 69±12 years and 44 % patients were females. Twenty-seven (11%) patients died within 30 days of hospital admission from complications related to PE. The PESI score was predictive of 30 day mortality in our patient cohort (p<0.001). Radiological parameters including clot burden were obtained from CTA results. Clot burden was assessed on the basis of location and distribution, mainly categorized as main pulmonary artery, segmental, subsegmental, saddle, unilateral, bilateral and was categorized as small, moderate and massive. A binary logistic regression showed a significant correlation of clot burden with 30-day mortality outcomes (p=0.04).
In addition to PESI score, clot burden is a useful indicator for identifying high risk PE population. Extensive clot burden can subsequently compromise gas exchange, cause right ventricular strain eventually leading to hemodynamic collapse. With the increasing use of the computed tomography angiography as the main diagnostic method in pulmonary embolism, radiolographic parameters should be included in the optimally risk stratifying patients presenting with acute PE.
Poster Hall, Hall A/B
Saturday, March 10, 2018, 10:00 a.m.-10:45 a.m.
Session Title: Trends in and Predictors of Mortality in Pulmonary Embolism
Abstract Category: 35. Pulmonary Hypertension and Venous Thrombo-Embolic Disease
Presentation Number: 1125-377
- 2018 American College of Cardiology Foundation