Clinical syndromes and clinical outcome in patients with pulmonary embolism: findings from the RIETE registry.
BACKGROUND
The influence of the clinical syndromes of pulmonary embolism (PE) on clinical outcome has not been evaluated.


METHODS
The Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) is an ongoing registry of consecutive patients with acute venous thromboembolism. In this study, all enrolled patients with acute PE without preexisting cardiac or pulmonary disease were classified into three clinical syndromes: pulmonary infarction, isolated dyspnea, or circulatory collapse. Their clinical characteristics, laboratory findings, and 3-month outcomes were compared.


RESULTS
As of January 2005, 4,145 patients with acute, symptomatic, objectively confirmed PE have been enrolled in RIETE. Of them, 3,391 patients (82%) had no chronic lung disease or heart failure: 1,709 patients (50%) had pulmonary infarction, 1,083 patients (32%) had isolated dyspnea, and 599 patients (18%) had circulatory collapse. Overall, 149 patients (4.4%) died during the first 15 days of therapy: 2.5% with pulmonary infarction, 6.2% with isolated dyspnea (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.7 to 3.8), and 6.5% with circulatory collapse (OR, 2.7; 95% CI, 1.7 to 4.2). From days 16 to 90, 31 patients had recurrent PE; 5 of 14 patients (36%) with pulmonary infarction died of their new PE, compared with 5 of 10 patients (50%) with isolated dyspnea, and all 7 patients (100%) with circulatory collapse.


CONCLUSIONS
PE patients with pulmonary infarction (50% of the whole series) had a significantly lower mortality rate both during initial therapy and after discharge.
Lobo
José Luís
JL
Servicio de Neumología, Unidad de Investigación, Hospital de Txagorritxu, Vitoria, Spain.
Zorrilla
Vanesa
V
Aizpuru
Felipe
F
Uresandi
Fernando
F
Garcia-Bragado
Ferrán
F
Conget
Francisco
F
Monreal
Manuel
M
D000208:Acute Disease; D000368:Aged; D016001:Confidence Intervals; D004417:Dyspnea / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D008297:Male; D016017:Odds Ratio; D011379:Prognosis; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D012008:Recurrence; D012042:Registries; D012769:Shock / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D016019:Survival Analysis; D013577:Syndrome; D015912:Thrombolytic Therapy; D020246:Venous Thrombosis / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality
D006495:Heparin, Low-Molecular-Weight