Introduction
Material and methods
Study design and outcomes
Statistical analysis
Results
Trends in initial presentation and risk stratification
Observation period | 09/2008–08/2016 (n = 605) | 09/2008–08/2010 (n = 145) | 09/2010–08/2012 (n = 140) | 09/2012–08/2014 (n = 165) | 09/2014–08/2016 (n = 155) | p for trend |
---|---|---|---|---|---|---|
Age (years) | 70 [56–77] | 70 [55–76] | 71 [55–77] | 69 [57–78] | 67 [55–77] | 0.94 |
Sex (female) | 320/605 (52.9%) | 77/145 (53.1%) | 78/140 (55.7%) | 87/165 (52.7%) | 78/155 (50.3%) | 0.53 |
BMI (kg/m2) | 27.6 [24.3–31.2] | 27.1 [23.9–31.0] | 27.8 [24.1–30.5] | 27.8 [25.0–33.1] | 26.8 [24.2–31.1] | 0.23 |
Risk factors for VTE and comorbidities | ||||||
Previous VTE | 161/603 (26.6%) | 37/145 (25.5%) | 40/140 (28.6%) | 53/163 (32.5%) | 31/155 (20%) | 0.43 |
Surgery (previous 4 weeks) | 109/605 (18.0%) | 20/145 (13.8%) | 19/140 (13.6%) | 34/165 (20.6%) | 36/155 (23.2%) | 0.012 |
Trauma (previous 4 weeks) | 18/605 (3.0%) | 5/145 (3.4%) | 5/140 (3.6%) | 2/165 (1.2%) | 6/155 (3.9%) | 0.86 |
Immobilisation (previous 4 weeks) | 128/604 (21.2%) | 54/145 (37.2%) | 25/139 (18.0%) | 20/165 (12.1%) | 28/155 (18.1%) | < 0.001 |
Travel | 31/603 (5.1%) | 9/145 (6.2%) | 7/139 (5.0%) | 5/164 (3.0%) | 10/155 (6.5%) | 0.88 |
Active cancer | 102/605 (16.9%) | 27/145 (18.6%) | 22/140 (15.7%) | 26/165 (15.8%) | 27/155 (17.4%) | 0.80 |
Chronic heart failure | 96/605 (15.9%) | 32/145 (22.1%) | 27/140 (19.3%) | 23/165 (13.9%) | 14/155 (9.0%) | 0.001 |
Chronic pulmonary disease | 93/605 (15.7%) | 20/145 (13.8%) | 23/140 (16.4%) | 22/165 (13.3%) | 28/155 (18.1%) | 0.46 |
Renal insufficiency | 207/589 (35.1%) | 39/144 (27.1%) | 57/139 (41.0%) | 64/161 (39.8%) | 47/145 (32.4%) | 0.39 |
Symptoms and clinical findings | ||||||
Chest pain | 292/605 (48.5%) | 71/145 (49.0%) | 72/138 (52.2%) | 90/165 (54.5%) | 59/154 (38.3%) | 0.11 |
Dyspnoea | 496/605 (82.4%) | 112/145 (77.2%) | 125/138 (90.6%) | 147/165 (89.1%) | 112/154 (72.7%) | 0.28 |
Haemoptysis | 18/605 (3.0%) | 5/145 (3.4%) | 3/139 (2.2%) | 6/165 (3.6%) | 4/154 (2.6%) | 0.87 |
Syncope | 94/604 (15.6%) | 30/145 (20.7%) | 22/140 (15.7%) | 24/165 (14.5%) | 18/154 (11.7%) | 0.034 |
Unilateral leg swelling | 138/600 (23.0%) | 46/144 (31.9%) | 38/137 (27.7%) | 29/165 (17.6%) | 25/154 (16.2%) | < 0.001 |
Tachycardia | 208/581 (32.5%) | 47/143 (30.8%) | 54/138 (37.7%) | 56/156 (31.4%) | 51/144 (30.6%) | 0.80 |
Hypotension | 34/570 (6.0%) | 10/142 (7.0%) | 10/137 (7.3%) | 10/154 (6.5%) | 4/137 (2.9%) | 0.15 |
Hypoxia | 147/511 (28.7%) | 32/116 (27.6%) | 36/120 (21.7%) | 51/146 (34.9%) | 28/129 (21.7%) | 0.49 |
RV dysfunction on TTE/CT | 284/549 (51.7%) | 70/134 (52.2%) | 83/139 (59.7%) | 74/159 (46.5%) | 57/117 (48.7%) | 0.21 |
Elevated troponin | 359/531 (67.6%) | 92/127 (72.4%) | 88/133 (66.2%) | 92/145 (63.4%) | 87/126 (69.0%) | 0.47 |
Elevated NT-proBNP | 263/460 (57%) | 78/132 (59.1%) | 79/127 (62.2%) | 53/96 (55.2%) | 53/105 (50.5%) | 0.40 |
Trends in in-hospital outcomes
Observation period | 09/2008–08/2016 | 09/2008–08/2010 | 09/2010–08/2012 | 09/2012–08/2014 | 09/2014–08/2016 | p for trend |
---|---|---|---|---|---|---|
A: In-hospital adverse outcome | 74/605 (12.2%) | 18/145 (12.4%) | 18/140 (12.9%) | 18/165 (10.9%) | 20/155 (12.9%) | 0.97 |
Low risk | 1/80 (1.3%) | 0/20 (0.0%) | 0/16 (0.0%) | 0/19 (0.0%) | 1/25 (4.0%) | 0.24 |
Intermediate-low risk | 13/304 (4.3%) | 3/66 (4.5%) | 3/58 (5.2%) | 3/91 (3.3%) | 4/89 (4.5%) | 0.86 |
Intermediate-high risk | 21/166 (12.7%) | 6/46 (13.0%) | 6/52 (11.5%) | 4/40 (10%) | 5/28 (17.9%) | 0.71 |
High-risk | 39/55 (70.9%) | 9/13 (69.2%) | 9/14 (64.3%) | 11/15 (73.3%) | 10/13 (76.9%) | 0.56 |
B: In-hospital all-cause mortality | 44/605 (7.3%) | 6/145 (4.1%) | 10/140 (7.1%) | 12/165 (7.3%) | 16/155 (10.3%) | 0.049 |
Low risk | 1/80 (1.3%) | 0/20 (0.0%) | 0/16 (0.0%) | 0/19 (0.0%) | 1/25 (4.0%) | 0.24 |
Intermediate-low risk | 10/304 (3.3%) | 1/66 (1.5%) | 3/58 (5.2%) | 3/91 (3.3%) | 3/89 (3.4%) | 0.70 |
Intermediate-high risk | 12/166 (7.2%) | 3/46 (6.5%) | 2/52 (3.8%) | 3/40 (7.5%) | 4/28 (14.3%) | 0.21 |
High-risk | 21/55 (38.2%) | 2/13 (15.4%) | 5/14 (35.7%) | 6/15 (40.0%) | 8/13 (61.5%) | 0.019 |
C: Death after discharge | 58/561 (10.3%) | 20/139 (14.4%) | 12/130 (9.2%) | 15/153 (9.8%) | 11/139 (7.9%) | 0.10 |
Low risk | 0/79 (0%) | 0/20 (0.0%) | 0/16 (0.0%) | 0/19 (0.0%) | 0/24 (0.0%) | n.c |
Intermediate-low risk | 29/294 (9.8%) | 7/65 (10.8%) | 4/55 (7.3%) | 11/88 (12.5%) | 7/86 (8.1%) | 0.83 |
Intermediate-high risk | 21/154 (13.6%) | 8/43 (18.6%) | 6/50 (12.0%) | 4/37 (10.8%) | 3/24 (12.5%) | 0.40 |
High-risk | 8/34 (23.5%) | 5/11 (45.5%) | 2/9 (22.2%) | 0/9 (0.0%) | 1/5 (20.0%) | 0.07 |
D: Overall 1-year mortality | 102/605 (16.9%) | 26/145 (17.9%) | 22/140 (15.7%) | 27/165 (16.4%) | 27/155 (17.4%) | 0.95 |
Low risk | 1/80 (1.3%) | 0/20 (0.0%) | 0/16 (0.0%) | 0/19 (0.0%) | 1/25 (4.0%) | 0.24 |
Intermediate-low risk | 39/304 (12.8%) | 8/66 (12.1%) | 7/58 (12.1%) | 14/91 (15.4%) | 10/89 (11.2%) | 1.00 |
Intermediate-high risk | 33/166 (19.9%) | 11/46 (23.9%) | 8/52 (15.4%) | 7/40 (17.5%) | 7/28 (25.0%) | 0.99 |
High-risk | 29/55 (52.7%) | 7/13 (53.8%) | 7/14 (50.0%) | 6/15 (40.0%) | 9/13 (69.2%) | 0.58 |
Trends in acute reperfusion treatment and impact on in-hospital outcomes
Adverse outcome | Resuscitation | Catecholamines | Mechanical ventilation | PE-related death | All-cause death | Major bleedinga | |
---|---|---|---|---|---|---|---|
Anticoagulation only | 33/515 (6.4%) | 8/515 (1.6%) | 22/515 (4.3%) | 21/514 (4.1%) | 12/515 (2.3%) | 23/515 (4.5%) | 21/515 (4.1%) |
Thrombolysis or thrombectomy | 37/56 (66.1%) | 21/56 (37.5%) | 32/56 (57.1%) | 27/56 (48.2%) | 17/56 (30.4%) | 20/56 (35.7%) | 13/56 (23.2%) |
Inclusion in PEITHO | 4/34 (11.8%) | 1/34 (2.9%) | 4/34 (11.8%) | 3/34 (8.8%) | 0/34 (0%) | 1/34 (2.9%) | 3/34 (8.8%) |
All patients | 74/605 (12.2%) | 30/605 (5.0%) | 58/605 (9.6%) | 51/605 (8.4%) | 29/605 (4.8%) | 44/605 (7.3%) | 37/605 (6.1%) |