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• W2037847605 abstract "In this issue of CHEST (see page 1212), Carson and associates show that patients with COPD and acute pulmonary embolism (PE) have a higher 1-year mortality (53.3%) than patients with COPD in whom PE was suspected but excluded (1-year mortality 29.1%). Among patients with COPD and pulmonary hypertension as well as PE, the 1-year mortality was 64.7%. Even in the absence of PE, the 1-year mortality in patients with COPD and pulmonary hypertension was 50.0%. This mortality far exceeds the 1-year mortality reported by others in patients with COPD, which, as Carson and associates indicate, is less than 15%.1Burrows B Earl RH. Prediction of survival in patients with chronic airways obstruction.Am Rev Respir Dis. 1969; 99: 865-871PubMed Google Scholar, 2Postma DS Burema J Gimeno F et al.Prognosis in severe chronic obstructive pulmonary disease.Am Rev Respir Dis. 1979; 119: 357-367PubMed Google Scholar, 3Posta DS Sluiter HJ. Prognosis of chronic obstructive pulmonary disease: the Dutch experience.Am Rev Respir Dis. 1989; 140: S100-05Crossref Google Scholar Patients reported by Carson and colleagues who had COPD, no pulmonary hypertension, and no PE had a 1-year mortality of 27.0% which also exceeded the mortality reported by others. The most common causes of death in these patients over the period of 1 year were neoplasm, infection, and cardiac disease (usually coronary disease). Pulmonary disease, including COPD, was not a common cause of death. When death occurred from PE, it was usually within 1 week. Recurrent PE was rare. These data indicate that the patients reported by Carson and associates comprised a complex and seriously ill group with compound disease. The death rates in 1 year, whether PE was present or absent, were over 30% in patients with neoplasms, heart failure, or interstitial lung disease. Did the pulmonary embolism contribute to death from other disease, such as heart failure? Was the pulmonary embolism a marker of advanced disease? I calculate from the data of Carson and colleagues that among patients with COPD and neoplasm, 6 of 6 (100%) with PE died compared to 12 of 20 (60%) with no PE. In patients with COPD and left-sided heart failure, 3 of 20 (15%) with PE died compared with 4 of 63 (6%) who did not have PE. Among patients with COPD and ischemic heart disease, 4 of 16 (25%) with PE died compared with 4 of 53 (8%) who did not have PE. Clearly, patients with COPD and associated neoplasm, left-sided heart failure, or ischemic heart disease did more poorly over 1 year if they had PE than if they did not have PE. Was the COPD more severe in the patients with PE? The data do not indicate the results of pulmonary function tests or values of the PaO2 before the PE or on follow-up among patients having PE compared with patients who did not have PE. Were the associated diseases (neoplasms, heart failure, ischemic heart disease) more severe in patients with PE? Was pulmonary function so impaired that even a slight residual perfusion defect in patients with PE may have contributed to their deaths when they had associated pulmonary abnormality? Did the patients with PE have residual deep venous thrombosis? Could silent PE have contributed to the death of these patients with impaired cardiorespiratory reserve? Clearly the data are not available to answer all of these questions, but perhaps the records of these patients may suggest some answers. The article by Carson and coworkers is one of many useful articles that have resulted from the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED). Hopefully, information related to unanswered questions will be forthcoming." @default.
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• W2037847605 date "1996-11-01" @default.
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• W2037847605 title "COPD, Pulmonary Embolism, and Death" @default.
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• W2037847605 doi "https://doi.org/10.1378/chest.110.5.1135" @default.
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