title: Differences in the clinical course of acute massive and submassive pulmonary embolism.
abstract: BACKGROUND
  Acute massive or submassive pulmonary embolism (PE) has high mortality, but the clinical course according to the location of onset (ie, in-hospital or out-of-hospital) is unknown.
  
  
  RESULTS
  In the present study 56 consecutive patients with acute massive or submassive PE were studied retrospectively and a comparison made of the clinical characteristics, and outcomes between in-hospital onset (Group A) and out-of-hospital onset (Group B). Patients in Group A (n=28) had more frequent comorbidities with hemodynamic instability (54% vs 4%, p<0.0001) and temporary risk factors (93% vs 11%, p<0.0001), whereas patients in Group B (n=28) had a longer duration of symptoms (median: 5.5 days vs 0.5 day; p<0.0001), and had higher systolic pulmonary artery pressure (63+/-17 mmHg vs 46+/-12 mmHg, p=0.0006). Although in-hospital mortality did not differ between the 2 groups, the recurrence rate was higher in Group B (23% vs 0%, p=0.03).
  
  
  CONCLUSIONS
  Patients who had in-hospital onset of PE had mostly temporary risk factors, unstable hemodynamics and a lower recurrence rate compared with the cases of out-of-hospital onset. In cases of in-hospital onset, prompt diagnosis and suitable treatment is needed to prevent fatalities and cases of out-of-hospital onset should be followed carefully for recurrence.
authors.affiliation: Intensive and Coronary Care Unit, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan. yamamoto56@nms.ac.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Naoki
authors.initials: N
authors.lastname: Sato
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tajima
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Takagi
authors.forename: Norishige
authors.initials: N
authors.lastname: Morita
authors.forename: Koichi
authors.initials: K
authors.lastname: Akutsu
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Fujita
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yasutake
authors.forename: Keiji
authors.initials: K
authors.lastname: Tanaka
authors.forename: Teruo
authors.initials: T
authors.lastname: Takano
mesh_terms: D000208:Acute Disease; D000368:Aged; D001158:Arteries; D005260:Female; D005740:Gases / Q000097:blood; D006439:Hemodynamics; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000097:blood / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D005740:Gases