Residual pulmonary vascular obstruction and recurrence after acute pulmonary embolism. A single center cohort study.
BACKGROUND
Up to 50% of patients with pulmonary embolism (PE) present lung perfusion defects after six months of anticoagulant treatment, suggesting residual pulmonary vascular obstruction (RPVO). The risk of recurrence in patients with RPVO remains unknown. The present study aims to assess the risk of recurrent venous thromboembolism (VTE) in patients with RPVO after a first symptomatic episode of PE.


METHODS
Consecutive patients who survived a first objectively proven acute PE, treated for at least three months with anticoagulants, were included and followed prospectively. RPVO was defined as a pulmonary vascular obstruction of >10% on ventilation/perfusion lung scan performed at inclusion. Objectively proven VTE recurrences were registered and confirmed by an investigator unaware of the result of the ventilation/perfusion lung scan.


RESULTS
Among the 310 patients (median age: 61years) included in the study, 60 (19%) had RPVO. During a median follow-up of 51.3months, 66 patients (21.2%, 95% CI [17.5-26.7]) experienced recurrent VTE. In an adjusted cox proportional hazards analysis, we identified RPVO (HR 1.94; 95% CI [1.11-3.39]; p=0.026) and unprovoked PE (HR 3.56; 95% CI [1.79-7.07]; p=0.00051) as independent risk factors for recurrent VTE whereas extended anticoagulation therapy (HR 0.19; 95% CI [0.07-0.55]; p=0.00014) was associated with a low risk of recurrence.


CONCLUSIONS
The results suggest that RPVO is an independent risk factor of recurrent VTE after a first PE.
Université Paris Descartes, Sorbonne Paris Cité, France; Service de Pneumologie et Soins Intensifs, Service de Pneumologie et Soins Intensifs, Hôpital Européen Georges Pompidou, AP-HP, Paris, France; INSERM UMR-S 1140, Paris, France. Electronic address: benjamin.planquette@aphp.fr.
Benjamin
B
Planquette
Université Paris Descartes, Sorbonne Paris Cité, France; Service de Pneumologie et Soins Intensifs, Service de Pneumologie et Soins Intensifs, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.
Alexis
A
Ferré
Medical Oncology Department, Centre Hospitalier Lyon Sud, Institut de Cancérologie des Hospices Civils de Lyon, Pierre-Bénite, France; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Université Lyon 1, Villeurbanne, France.
Julien
J
Peron
Université Paris Descartes, Sorbonne Paris Cité, France; Service de Pneumologie et Soins Intensifs, Service de Pneumologie et Soins Intensifs, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.
Amandine
A
Vial-Dupuy
Université Paris Descartes, Sorbonne Paris Cité, France; Service de Pneumologie et Soins Intensifs, Service de Pneumologie et Soins Intensifs, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.
Jean
J
Pastre
Université Paris Descartes, Sorbonne Paris Cité, France; Service de Pneumologie et Soins Intensifs, Service de Pneumologie et Soins Intensifs, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.
Gisèle
G
Mourin
Université Paris Descartes, Sorbonne Paris Cité, France; Médecine Vasculaire - Cardiologie, Centre de Diagnostic et de Thérapeutique, Hôpital Hôtel Dieu, AP-HP, Paris, France.
Joseph
J
Emmerich
Service de Médecine Nucléaire, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.
Marie-Anne
MA
Collignon
Université Paris Descartes, Sorbonne Paris Cité, France; Service de Pneumologie et Soins Intensifs, Service de Pneumologie et Soins Intensifs, Hôpital Européen Georges Pompidou, AP-HP, Paris, France; INSERM CIC-1418, Paris, France; INSERM UMR-S 970, Paris, France.
Guy
G
Meyer
Université Paris Descartes, Sorbonne Paris Cité, France; Service de Pneumologie et Soins Intensifs, Service de Pneumologie et Soins Intensifs, Hôpital Européen Georges Pompidou, AP-HP, Paris, France; INSERM UMR-S 1140, Paris, France.
Olivier
O
Sanchez
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008168:Lung / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011651:Pulmonary Artery / Q000473:pathology*; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D012008:Recurrence; D012307:Risk Factors
D000925:Anticoagulants
Lung scintigraphy; Management of pulmonary embolism; Pulmonary circulation physiopathology; Pulmonary embolism; Risk factor; Thrombosis