title: Clinical Prognosis of Nonmassive Central and Noncentral Pulmonary Embolism: A Registry-Based Cohort Study.
abstract: BACKGROUND
  Whether the localization of nonmassive pulmonary embolism (PE) is associated with the short-term and long-term prognosis of patients remains unknown. Our aim was to characterize associations of nonmassive PE localization with risks of recurrent VTE, major bleeding, and mortality during and after anticoagulation.
  
  
  METHODS
  Among participants of the Registro Informatizado de la Enfermedad ThromboEmbòlica (RIETE) registry with incident symptomatic nonmassive PE diagnosed by CT scan, we compared risks of recurrent VTE, major bleeding, and mortality during and after anticoagulation between central PE (main pulmonary artery) and noncentral PE (more peripheral arteries) using Cox proportional hazard-adjusted models.
  
  
  RESULTS
  Of the 6,674 participants, patients with central PE (40.5%) had age (mean 66 years), sex (46.9% male sex), and proportion of idiopathic (45.0%) and cancer-related (22.3%) PE that were similar to those of patients with noncentral PE. During anticoagulation (5,256.1 patient-years), the risk of recurrent VTE was similar between the two groups (2.5 vs 2.1 per 100 patient-years; adjusted hazard ratio [aHR], 1.32; 95% CI, 0.91-1.90), as were risks of major bleeding and mortality. After anticoagulation was discontinued (2,175.4 patient-years), participants with central PE had a borderline greater risk of recurrent VTE than did participants with noncentral PE (11.0 vs 8.0 per 100 patient-years; aHR, 1.34; 95% CI, 1.01-1.78) but not when restricted to participants after unprovoked PE (13.8 vs 11.9 per 100 patient-years; aHR, 1.15; 95% CI, 0.79-1.68; P = .48). Risks of major bleeding and mortality were similar.
  
  
  CONCLUSIONS
  In nonmassive PE, central localization of PE is associated with greater risk of recurrent VTE after anticoagulation cessation. However, the low magnitude of this association and the absence of association after unprovoked PE suggest that the clinical relevance of this finding is limited and that the duration of anticoagulation should not be tailored to PE localization after nonmassive unprovoked PE.
authors.affiliation: Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; Division of General Internal Medicine, Université de Sherbrooke, Sherbrooke, Canada (on leave). Electronic address: bobby.gouin@usherbrooke.ca.
authors.forename: Bobby
authors.initials: B
authors.lastname: Gouin
authors.affiliation: Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Blondon
authors.affiliation: Respiratory Department, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Jiménez
authors.affiliation: Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Fernández-Capitán
authors.affiliation: Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
authors.forename: Henri
authors.initials: H
authors.lastname: Bounameaux
authors.affiliation: Department of Internal Medicine, Hospital Olot i Comarcal de la Garrotxa, Gerona, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Soler
authors.affiliation: Department of Laboratory of Analysis, Ospedale Galliera, Genoa, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Duce
authors.affiliation: Department of Internal Medicine, Hospital Municipal de Badalona, Barcelona, Spain.
authors.forename: Joan Carles
authors.initials: JC
authors.lastname: Sahuquillo
authors.affiliation: Department of Internal Medicine, Hospital Universitario de La Princesa, Madrid, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Ruiz-Giménez
authors.affiliation: Department of Internal Medicine, Hospital Universitario Germans Trias i Pujol de Badalona, Barcelona, Spain, and Universidad Católica de Murcia, Murcia, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Monreal
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D012008:Recurrence; D012042:Registries; D012306:Risk; D036542:Tomography, Spiral Computed
chemical_list: D000925:Anticoagulants
keywords: VTE; prognosis; pulmonary embolism; recurrence; thrombosis