Prognostic significance of deep vein thrombosis in patients presenting with acute symptomatic pulmonary embolism.
BACKGROUND
Concomitant deep vein thrombosis (DVT) in patients with acute pulmonary embolism (PE) has an uncertain prognostic significance.


OBJECTIVE
In a cohort of patients with PE, this study compared the risk of death in those with and those without concomitant DVT.


METHODS
We conducted a prospective cohort study of outpatients diagnosed with a first episode of acute symptomatic PE. Patients underwent bilateral lower extremity venous compression ultrasonography to assess for concomitant DVT.


RESULTS
The primary study outcome, all-cause mortality, and the secondary outcome of PE-specific mortality were assessed during the 3 months of follow-up after PE diagnosis. Multivariate Cox proportional hazards regression was done to adjust for significant covariates. Of 707 patients diagnosed with PE, 51.2% (362 of 707) had concomitant DVT and 10.9% (77 of 707) died during follow-up. Patients with concomitant DVT had an increased all-cause mortality (adjusted hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.24 to 3.38; P = 0.005) and PE-specific mortality (adjusted HR, 4.25; 95% CI, 1.61 to 11.25; P = 0.04) compared with those without concomitant DVT. In an external validation cohort of 4,476 patients with acute PE enrolled in the international multicenter RIETE Registry, concomitant DVT remained a significant predictor of all-cause (adjusted HR, 1.66; 95% CI, 1.28 to 2.15; P < 0.001) and PE-specific mortality (adjusted HR, 2.01; 95% CI, 1.18 to 3.44; P = 0.01).


CONCLUSIONS
In patients with a first episode of acute symptomatic PE, the presence of concomitant DVT is an independent predictor of death in the ensuing 3 months after diagnosis. Assessment of the thrombotic burden should assist with risk stratification of patients with acute PE.
Jiménez
David
D
Respiratory Department, Ramón y Cajal Hospital, 28034 Madrid, Spain. djc_69_98@yahoo.com
Aujesky
Drahomir
D
Díaz
Gema
G
Monreal
Manuel
M
Otero
Remedios
R
Martí
David
D
Marín
Elena
E
Aracil
Enrique
E
Sueiro
Antonio
A
Yusen
Roger D
RD
D000208:Acute Disease; D000368:Aged; D005260:Female; D006801:Humans; D007866:Leg / Q000000981:diagnostic imaging; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000150:complications* / Q000401:mortality*; D012008:Recurrence; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000150:complications* / Q000000981:diagnostic imaging