title: Pulmonary embolism risk stratification by European Society of Cardiology is associated with recurrent venous thromboembolism: Findings from a long-term follow-up study.
abstract: Venous thromboembolism (VTE) recurrence carries significant mortality and morbidity. Accurate risk assessment and effective treatment for patients with acute pulmonary embolism (PE) is important for VTE recurrence prevention. We examined the association of VTE recurrence with risk stratification and PE treatment. We enrolled 627 patients with a first episode of confirmed PE. Baseline clinical information was collected. PE severity was assessed by the European Society of Cardiology's (ESC) risk stratification, the simplified PE Severity Index (sPESI) and the Qanadli score of clot burden. Patients were followed for 1-5 years. The cumulative recurrent VTE and all-cause death were documented. The association between recurrent VTE and risk factors was analyzed. The cumulative incidences of recurrent VTE were 4.5%, 7.3%, and 13.9% at 1, 2, and 5 years of follow-up, respectively. The VTE recurrence was associated with higher (high- and intermediate-) risk stratification predicted by ESC model (HR 1.838, 95% CI 1.318-2.571, P<0.001), as well as with unprovoked PE (HR 2.809, 95% CI 1.650-4.781, P b 0.001) and varicose veins (HR 4.747, 95% CI 2.634-8.557, P<0.001). The recurrence was negatively associated with longer (≥6 months) anticoagulation (HR 0.473, 95% CI 0.285-0.787, P=0.004), especially in patients with higher risk (HR 0.394, 95% CI 0.211-0.736, P=0.003) and unprovoked PE (HR 0.248, 95% CI 0.122-0.504, P<0.001). ESC high-risk and intermediate-risk PE, unprovoked PE and varicose veins increase recurrence risk. Longer anticoagulation treatment reduces recurrence, especially in higher risk and unprovoked PE patients.
authors.affiliation: Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, PR China.
authors.forename: Shuai
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, PR China.
authors.forename: Zhenguo
authors.initials: Z
authors.lastname: Zhai
authors.affiliation: Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, PR China.
authors.forename: Yuanhua
authors.initials: Y
authors.lastname: Yang
authors.affiliation: National Clinical Research Center of Respiratory Medicine, Beijing, PR China.
authors.forename: Jianguo
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, PR China.
authors.forename: Tuguang
authors.initials: T
authors.lastname: Kuang
authors.affiliation: Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, PR China.
authors.forename: Wanmu
authors.initials: W
authors.lastname: Xie
authors.affiliation: Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, PR China.
authors.forename: Suqiao
authors.initials: S
authors.lastname: Yang
authors.affiliation: Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, PR China.
authors.forename: Fangfang
authors.initials: F
authors.lastname: Liu
authors.affiliation: Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, PR China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, PR China.
authors.forename: Juanni
authors.initials: J
authors.lastname: Gong
authors.affiliation: Department of Cardiothoracic Surgery, Baylor College of Medicine, Houston, USA.
authors.forename: Ying H
authors.initials: YH
authors.lastname: Shen
authors.affiliation: National Clinical Research Center of Respiratory Medicine, Beijing, PR China; China-Japan Friendship Hospital, Beijing, PR China; Department of Respiratory Medicine, Capital Medical University, Beijing, PR China. Electronic address: cyh-birm@263.net.
authors.forename: Chen
authors.initials: C
authors.lastname: Wang
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage*; D002681:China / Q000453:epidemiology; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D011655:Pulmonary Embolism / Q000188:drug therapy*; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D012955:Societies, Medical; D054556:Venous Thromboembolism / Q000188:drug therapy* / Q000453:epidemiology*
chemical_list: D000925:Anticoagulants
keywords: European Society of Cardiology; Prognosis; Pulmonary embolism; Recurrence; Risk stratification; Venous thromboembolism