Clinical outcome after a negative spiral CT pulmonary angiographic finding in an inpatient population from cardiology and pneumology wards.
OBJECTIVE
The purpose of this study was to assess the clinical follow-up of a negative spiral CT (SCT) angiographic finding after a suspicion of acute pulmonary embolism (PE) in a population of inpatients with cardiac and/or respiratory disease. In this high-risk population, clinical findings suggestive of PE are frequently misleading.


METHODS
One hundred seventy-five consecutive patients hospitalized in cardiac and pneumology wards underwent SCT angiography for suspected PE over a 30-month period. Angiographic findings were positive in one third. For the 117 patients with negative SCT angiographic findings, a clinical follow-up during a minimum of 6 months was assessed, particularly in relation to recurrent thromboembolism, mortality, and cause of death.


RESULTS
The mean +/- SD follow-up was 21 +/- 11.5 months, and five patients were unavailable for follow-up. Of the 117 patients with negative findings, 81 patients did not receive anticoagulant therapy and 46 patients received anticoagulation for cardiac disease or deep venous thrombosis. Twenty-two patients died during the follow-up period, 3 of them during the first 3 months following the initial event from an undetermined cause. In patients still alive, a new PE occurred in two cases. Patients with a poor cardiopulmonary reserve did not present any recurrent events. In this population, tests other than imaging (d-dimers, cardiac echocardiography, or venous ultrasound) contributed little to eliminate the diagnosis of PE.


CONCLUSIONS
Whether or not early deaths are considered or not to be related to a recurrent PE, the rate of recurrence after a negative SCT angiographic finding varied between 1.8% and 4.9%. SCT angiography can be used confidently to rule out significant PE, and may prevent further investigations and unnecessary treatment in an inpatient population with cardiac and/or respiratory diseases.
Bourriot
Katia
K
Service de Cardiologie, Hôpital Cardiologique du Haut-Lévêque, Pessac, France.
Couffinhal
Thierry
T
Bernard
Virginie
V
Montaudon
Michel
M
Bonnet
Jacques
J
Laurent
François
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D016507:Cardiology Service, Hospital; D005260:Female; D005602:France; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000401:mortality; D006748:Hospital Departments; D006801:Humans; D008171:Lung Diseases / Q000000981:diagnostic imaging* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000401:mortality; D012008:Recurrence; D015996:Survival Rate; D036542:Tomography, Spiral Computed