pulmonary embolism prognosis

pulmonary embolism prognosis

 Prognosis of patients with pulmonary thromboembolism

Acute pulmonary thromboembolism (PE) is a serious condition. When the PET scan shows a significant degree of pulmonary arterial obstruction in the presence of previous cardiopulmonary disease, it can lead to ventricular dysfunction, which is associated with hemodynamic instability and which, potentially, can lead to the death of the patient.

It is estimated that the overall mortality of PE is 2-6% (if there is no hemodynamic instability), but it reaches 30% if the patient has hemodynamic instability or shock. In addition, 25% of patients do not survive beyond one year after diagnosis, although most of these deaths are related primarily to underlying diseases, such as cancer or chronic heart disease.

Even after the acute phase of PE, the clinical course can be complicated by thrombotic and non-thrombotic events (hemorrhagic processes). Another possible complication is chronic obstruction of the pulmonary arteries by organized clots, called chronic thromboembolic pulmonary arterial hypertension (HTPTC).

The authors of the present study evaluated the long-term prognosis of PE in terms of the appearance of a series of complications. To this end, they studied about 1,000 patients with PE and 334 without PE (control group) who were recruited consecutively in a Dutch hospital between 2001 and 2007, and who did a clinical follow-up until July 2008. Within the group of patients with PET, differentiated between those with "non-induced" PE (n = 308), that is, patients without risk factors (active cancer, immobilization of more than 3 days and recent long-distance flight, fracture or recent limb surgery, pregnancy or puerperal period, or administration of oral contraceptives), and those with "induced" PE or with risk factors (n = 558).

The study showed that patients with "non-induced" PE had a lower overall mortality risk than patients with "induced" PE (added risk [RA] 0.59), but an increased risk of complications such as recurrent venous thromboembolism (( RA 2.1), cancer (RA 4.4), cardiovascular events (RA 2.6) and HTPTC (RA 2.6). Patients without PE showed a similar risk for cancer and cardiovascular events than patients with PE. induced ", but a lower risk for the other complications.The proportion of patients with PE (both" induced "and" not induced ") without complications after one year was 70%, although by the second year it decreased to 60%, and after 4 years less than half of the patients were without complications, while in the group of patients without PE (control group) this proportion was 84%.

The authors stress that PE remains a serious pathology that leads to high mortality and a high risk of associated complications. Therefore, it is advisable to carry out a close clinical follow-up in the 4 years after the diagnosis, since almost half of the patients will die or be diagnosed of other complications, such as cancer, recurrent thrombotic venous disease, chronic pulmonary hypertension or cardiovascular disease. The challenge of future health programs is to provide the necessary tools to adjust treatment regimens and carry out a personalized clinical follow-up for the individualized prognosis of each patient.



Klok FA, Zondag W, Van Kralingen KW, et al. Patient outcomes after acute pulmonary embolism. A pooled survival analysis of different adverse events. Am J Respir Crit Care Med. 2010; 181: 501-506