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• W2022199666 abstract "Conclusion: Within 4 years of acute pulmonary embolism (PE), half the patients will have an additional serious adverse clinical event. Summary: Most articles on acute PE focus on incidence and case fatality rates. There are little data on the long-term fate of the patients. This report, however, does provide a more long-term perspective of the fate of patients with PE. We know that death related to PE occurs in approximately 2% to 6% of patients with a hemodynamically stable PE and in >30% of patients with PE presenting with shock or hemodynamic instability (Chest 2002;121:877-905; Arch Intern Med 2004;164:92-96). About 25% of patients do not survive the first year after the diagnosis of PE, with most deaths relating to cancer or chronic heart disease rather than to PE itself (N Engl J Med 1992; 326:1240-1245). We also know that patients with PE are at risk for recurrent PE, chronic thromboembolic pulmonary hypertension, arterial cardiovascular events, and a new diagnosis of cancer (N Engl J Med 1998;338:1169-73; AMA 2005;293:2352-61). The goal of this study was to assess long-term risk for adverse events after PE. The authors analyzed consecutive patients diagnosed with PE between January 2001 and July 2007. Patients were monitored until July 2008 for occurrence of adverse clinical events, defined as death, symptomatic or recurrent venous thromboembolism, cancer, arterial cardiovascular events, and chronic thromboembolic pulmonary hypertension. Statistical analysis included calculation of hazard ratios (HR) and 95% confidence intervals (CI) for individual end points and a combined end point with adjustments for confounders. There were 308 patients with unprovoked and 558 patients with provoked PE. An additional 334 patients without PE were also studied. Median follow-up was 3.3 years. Patients with unprovoked PE had a lower overall risk for death than patients with provoked PE (HR, 0.59; 95% CI, 0.43-0.82). However, they had a higher risk for non-malignancy-related death (HR, 1.8; 95% CI, 1.3-2.5), recurrent venous thromboembolism (HR, 2.1; 95% CI, 1.3-3.1), cancer (HR, 4.4; 95% CI, 2.0-10), cardiovascular events (HR, 2.6; 95% CI, 1.5-3.8), and chronic thromboembolic pulmonary hypertension (1.5% vs 0%). The fraction of patients with provoked and unprovoked PE without events after 1 year was 70%, decreased to <60% after 2 years, and was <50% after 4 years. In comparison, 85% of patients without PE were free of clinical events after 4 years. Comment: These data are sobering. More than 70% of patients with PE will have had a major clinical event by 4 years after the PE. One is tempted to ascribe the late events to the initial occurrence of the PE, but clearly, a diagnosis of cancer as a late clinical event is not caused by the PE. Nevertheless, the high rate of late adverse events that are potentially related to the initial PE (recurrent PE, recurrent venous thromboembolism, and thromboembolic pulmonary hypertension) argues for better protocols for prevention of PE through individual risk stratification of at-risk patients." @default.
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• W2022199666 date "2010-09-01" @default.
• W2022199666 modified "2023-09-30" @default.
• W2022199666 title "Patient Outcomes after Acute Pulmonary Embolism: A Pooled Survival Analysis of Different Adverse Events" @default.
• W2022199666 doi "https://doi.org/10.1016/j.jvs.2010.07.041" @default.
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