Korean J Med.
2000 Mar;58(3):293-300.
Clinical characteristics and predictors of in-hospital mortality for patients
with acute major pulmonary embolism
- Affiliations
-
- 1Cardiology Division, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
Abstract
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BACKGROUND: Pulmonary embolism is a relatively common disease but may also be manifestated
as a lethal disease. Most previous studies on pulmonary embolism included hemodynamically stable
patients who were able to tolerate a confirmative diagnostic workup, including ventilation-perfusion
lung scan or pulmonary angiography. However, in most cases of acute massive pulmonary embolism,
patients are unstable to tolerate a confirmative diagnostic workup. Studies of only stable patients
with pulmonary embolism may have a bias on evaluating the clinical course and prognosis of pulmonary
embolism. Therefore, we designed a study to observe the clinical manifestations, diagnostic methods,
treatment modality, and to investigate the prognostic factors of patients with acute pulmonary embolism
who present with overt or impending right heart failure using the diagnostic criteria suggested by
MAPPET study.
METHODS
Among 103 patients diagnosed as pulmonary embolism from 1990 to 1997,
63 patients(male/female : 21/42, mean age : 56 15) were enrolled as acute major
pulmonary embolism by MAPPET's diagnostic criteria. Patients were included
in the study if they showed clinical, echocardiographic and cardiac catheterization
findings signifying acute right heart failure or pulmonary hypertension due to
pulmonary embolism, together with: 1) a diagnostic pulmonary angiogram,
or 2) a lung scan indicating high probability of pulmonary embolism, or
3) at least 3 of the followings: 1) syncope; 2) tachycardia (heart rate > 100 beats /min);
3) dyspnea or tachypnea (> 24 breaths/min or need for mechanical ventilation);
4) arterial hypoxemia (partial arterial pressure of oxygen < 70mmHg while breathing
room air) in the absence of pulmonary infiltrates on chest x-ray; 5) ECG signs
of right heart strain.
RESULTS
Among the 63 patients, 15 patients(23.8%) did not have an underlying
disease. Eleven patients(17.5%) had malignancy, 8 patients had an operation
in the recent 20 days, 6 patients had chronic pulmonary disease, 5 patients
had a history of congestive heart failure and cerebrovascular accident
respectively, 4 patients had a previous history of pulmonary embolism,
3 patients had vasculitis such as Behcets' disease and systemic lupus
erythematosus and a history of venous thrombosis, respectively. The main
clinical manifestation on the time of diagnosis was dypnea in 55 patients(87.3%),
which was the most frequent, and chest pain in 18 patients(28.6%),
syncope in 10 patients(15.9%), and tachycardia in 2 patients(3.2%).
The diagnostic methods were echocardiography(43 patients, 68.3%), lung perfusion
scan(39 patients, 61.9%), chest computed tomography(16 patients, 26.4%), pulmonary
angiography(4 patients, 6.3%) and right heart catherization (2 patients, 3.2%).
In order to examine deep vein thrombosis, lower extremity Duplex ultrusonography and
venography were performed in 11 patients(17.5%) and 7 patients(11.1%) respectively.
The overall in-hospital mortality was 38.1%(24 patients). The factors influencing
in-hospital mortality were associated malignancy(p< 0.01) and unstable
vital sign(systolic blood pressure of less than 90mmHg)(p< 0.05).
CONCLUSION
Acute pulmonary embolism with overt or impending right heart failure
is a significant lethal disease with a high in-hospital mortality.
The predictors of mortality were associated malignancy
and unstable vital sign.