title: The prognostic impact of chest pain in 1306 patients presenting with confirmed acute pulmonary embolism.
abstract: BACKGROUND
  The prognostic influence of chest pain in patients presenting with pulmonary embolism has not been well defined. We investigated whether the presence of chest pain at presentation affected the mortality of patients with acute pulmonary embolism.
  
  
  METHODS
  Retrospective cohort study of consecutive patients admitted to a tertiary hospital with confirmed acute pulmonary embolism from 2000 to 2012, with study outcomes tracked using a state-wide death registry.
  
  
  RESULTS
  Of the 1306 patients included in the study, 771 (59%) had chest pain at presentation. These patients were younger with fewer comorbidities, and had lower 6-month mortality compared to patients without chest pain (5% vs 15%, P<0.001). Chest pain was consistently found to be an independent predictor of 6-month mortality in three separate multivariable models (range of hazard ratios 0.52-0.60, all with P<0.05). The addition of chest pain to a multivariable model that included the simplified pulmonary embolism severity index, haemoglobin, and sodium led to a significant net reclassification improvement of 18% (P<0.001).
  
  
  CONCLUSIONS
  Chest pain is a novel, favourable prognostic marker in patients with acute pulmonary embolism.
authors.affiliation: Department of Cardiology, Concord Hospital, University of Sydney, Australia.
authors.forename: Christopher C Y
authors.initials: CC
authors.lastname: Wong
authors.affiliation: Department of Cardiology, Concord Hospital, University of Sydney, Australia; Vascular Biology Group, ANZAC Research Institute, Australia. Electronic address: chin.ng@sydney.edu.au.
authors.forename: Austin C C
authors.initials: AC
authors.lastname: Ng
authors.affiliation: Department of Cardiology, Concord Hospital, University of Sydney, Australia; Vascular Biology Group, ANZAC Research Institute, Australia.
authors.forename: Jerrett K
authors.initials: JK
authors.lastname: Lau
authors.affiliation: Department of Cardiology, Concord Hospital, University of Sydney, Australia; Vascular Biology Group, ANZAC Research Institute, Australia.
authors.forename: Vincent
authors.initials: V
authors.lastname: Chow
authors.affiliation: Department of Cardiology, Concord Hospital, University of Sydney, Australia.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Sindone
authors.affiliation: Department of Cardiology, Concord Hospital, University of Sydney, Australia; Vascular Biology Group, ANZAC Research Institute, Australia.
authors.forename: Leonard
authors.initials: L
authors.lastname: Kritharides
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000000981:diagnostic imaging* / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D011379:Prognosis; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000401:mortality*; D012189:Retrospective Studies
keywords: Chest pain; Prognosis; Pulmonary embolism