title: Thrombolytic therapy delay is independent predictor of mortality in acute pulmonary embolism at emergency service.
abstract: Acute pulmonary embolism (PE) carries a high risk of morbidity and mortality. Delays in diagnosis or therapy may result in sudden, fatal deterioration; therefore, rapid diagnosis and an appropriate therapeutic approach are needed. We aimed to investigate the effect of delaying thrombolytic administration on the mortality rate in a suspected PE. We retrospectively analyzed 49 consecutive patients who were aged 18 years or older and received thrombolysis for a high-risk PE without a major contraindication. All patients were classified according to the time of onset of the thrombolytic therapy. Patients experiencing cardiopulmonary arrest were analyzed from the time of admission to thrombolytic administration with 10-minute cutoff values. Data were analyzed by a regression analysis and a receiver operating characteristic (ROC) analysis for significant and independent associated risk factors and in-hospital mortality. Mortality was seen in 17 of the 49 cases. Thirteen of these had received thrombolytic therapy 1 hour after their emergency department (ED) admission. Among all cases, the mortality rate was 35%. The ROC analysis indicated that a > 97-second delayed thrombolytic administration time was associated with mortality with 53% sensitivity and 91% specificity (area under the curve, 0.803; 95% confidence interval, 0.668-0.938). In the logistic regression, a 5-minute delay in thrombolytic therapy (beta = 1.342; 95% confidence interval, 1.818-2.231; p = 0.001) was associated with in-hospital mortality in the multivariable model. No major bleeding complications were seen in PE survivors. We conclude that early onset thrombolytic therapy in the ED for high-risk and hemodynamically worsening patients appears safe and life-saving.
authors.affiliation: Department of Emergency Medicine, Antalya Education and Research Hospital, Antalya, Turkey. Electronic address: inan_beydilli@hotmail.com.
authors.forename: İnan
authors.initials: İ
authors.lastname: Beydilli
authors.affiliation: Department of Emergency Medicine, Antalya Education and Research Hospital, Antalya, Turkey.
authors.forename: Fevzi
authors.initials: F
authors.lastname: Yılmaz
authors.affiliation: Department of Emergency Medicine, Antalya Education and Research Hospital, Antalya, Turkey.
authors.forename: Bedriye Müge
authors.initials: BM
authors.lastname: Sönmez
authors.affiliation: Department of Emergency Medicine, Antalya Education and Research Hospital, Antalya, Turkey.
authors.forename: Nalan
authors.initials: N
authors.lastname: Kozacı
authors.affiliation: Department of Cardiology, İzmir University Faculty of Medicine, İzmir, Turkey.
authors.forename: Akar
authors.initials: A
authors.lastname: Yılmaz
authors.affiliation: Department of Emergency Medicine, Antalya Education and Research Hospital, Antalya, Turkey.
authors.forename: İbrahim Halil
authors.initials: İH
authors.lastname: Toksul
authors.affiliation: Department of Emergency Medicine, Bitlis State Hospital, Bitlis, Turkey.
authors.forename: Ramazan
authors.initials: R
authors.lastname: Güven
authors.affiliation: Department of Emergency Medicine, Antalya Education and Research Hospital, Antalya, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Avcı
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003710:Demography; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000473:pathology; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality*; D012372:ROC Curve; D012044:Regression Analysis; D015912:Thrombolytic Therapy
keywords: Echocardiography; Thromboembolism; Thrombolytic agent