Latest management and outcomes of major pulmonary embolism in the cardiovascular disease early transport system: Tokyo CCU Network.
BACKGROUND
Major pulmonary embolism (PE) is a life-threatening disorder associated with high mortality and morbidity. The clinical characteristics and outcomes in major PE managed by a well-organized cardiac care regional urban network and hospitals have not been clarified and were examined in the present study.


RESULTS
Data from the Tokyo CCU Network registered cohort in 2005-2006 were analyzed. Among 193 patients with major PE and known severities and outcomes, 42 patients had massive PE, defined as cardiogenic shock or cardiac arrest. The median time from symptom onset to CCU admission was 16.3 h. The in-hospital mortality of the 124 patients who received reperfusion therapy was lower than that of the 69 patients that did not receive reperfusion therapy (11.3% vs 18.8%; P=0.15). In multiple logistic regression analyses after adjusting for advanced age and sex, reperfusion therapy was selected as a significant predictor for in-hospital death (adjusted odds ratio, 0.34; 95%CI, 0.12-0.95; P=0.039), in addition to massive type (adjusted odds ratio, 14.02; 95%CI, 4.71-41.76; P<0.0001).


CONCLUSIONS
Early transport and specific reperfusion therapy for major PE were effectively performed by the Tokyo CCU Network, suggesting the efficacy of a specialty management system for major PE.
D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances / Q000458:organization & administration*; D015331:Cohort Studies; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission; D010348:Patient Care Team / Q000458:organization & administration; D015397:Program Evaluation; D011655:Pulmonary Embolism / Q000150:complications / Q000401:mortality / Q000628:therapy*; D012040:Regional Health Planning / Q000458:organization & administration*; D012042:Registries; D015424:Reperfusion / Q000009:adverse effects / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014041:Tokyo / Q000453:epidemiology; D016896:Treatment Outcome; D019037:Urban Health Services / Q000458:organization & administration*