title: Computerized tomographic finding of saddle pulmonary embolism is associated with high mortality in cancer patients.
abstract: BACKGROUND
  Large pulmonary embolism (PE) is associated with high mortality in cancer patients. Several risk stratification methods have been used in PE setting. While computer-assisted tomography (CT) is now the preferred diagnostic modality for PE, its prognostic value is not well established.
  
  
  METHODS
  A retrospective study of patients discharged from our centre between 2000 and 2006 with a PE diagnosis identified 52 patients with thrombus in the main pulmonary artery or the right or left branch. Clinical, echocardiographic and CT data were reviewed; vital status was determined 1 month and 1 year after index event. Patients were divided into saddle (defined as main pulmonary artery thrombus) and non-saddle PE. Multivariate logistic regression was applied to predict vital status, with patient age and CT parameters as predictors.
  
  
  RESULTS
  Eighteen out of 52 patients were found to have a saddle PE. No significant difference was found between the group characteristics, although saddle PE patients were more likely to receive thrombolytic therapy (27.8% vs 2.9%, P = 0.02) and have an echocardiogram within 30 days of PE (61.1% vs 29.4%, P = 0.03). Overall mortality at 1 month was 9.6% with no difference between groups. At 1 year, mortality rates in saddle PE were significantly higher (83.3% vs 41.2%, P = 0.004). Presence of saddle PE was associated with an odds ratio of death within 1 year of 7.41 (95% confidence interval: 1.75-31.46, P = 0.007).
  
  
  CONCLUSIONS
  The relatively simple distinction of saddle versus non-saddle PE by CT findings may provide a straightforward method for risk stratification, and remains useful up to 1 year after the index event.
authors.affiliation: Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. syusuf@mdanderson.org
authors.forename: S W
authors.initials: SW
authors.lastname: Yusuf
authors.forename: G
authors.initials: G
authors.lastname: Gladish
authors.forename: D J
authors.initials: DJ
authors.lastname: Lenihan
authors.forename: X
authors.initials: X
authors.lastname: Lei
authors.forename: J-B
authors.initials: JB
authors.lastname: Durand
authors.forename: J
authors.initials: J
authors.lastname: Swafford
authors.forename: I N
authors.initials: IN
authors.lastname: Daher
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality*; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed