Impact of Pulmonary Arterial Clot Location on Pulmonary Embolism Treatment and Outcomes (90 Days).
Pulmonary embolism (PE) is common and management is based on risk stratification. The significance of clot location in submassive and massive PE is unclear. Data from a prospectively gathered database of submassive and massive PE were used for analysis. Available data included patient presentation, diagnostics, treatment, and outcome. Comparisons were made according to clot location: central or peripheral. A multivariable model was used for composite outcome of death or right ventricular (RV) strain at 90 days. Among 269 patients, there were no significant demographic differences between patients with peripheral and central PE. Peripheral PE was more likely to present with hypotension (46.4% vs 32.6%; p = 0.02), but central PE was more likely to have RV strain on echocardiography (76.7% vs 57.7%, p <0.001) and computed tomography (58.1% vs 32.0%, p <0.0001). Peripheral PE was more likely to receive anticoagulation as the only form of therapy (69.1% vs 55.8%; p = 0.03), and central PE was more likely to receive catheter-directed therapies (18.3% vs 3.3%; p <0.001). Nonetheless, peripheral PE had higher 30- and 90-day all-cause mortality (18.5% vs 9.3%; p = 0.03; 25.9% vs 13.5%; p = 0.02, respectively). In a multivariable analysis, the only independent predictor of death or RV strain at 90 days was increased age (odds radio 1.35, CI 1.06 to 1.72 per 10 years). Specifically, neither clot location nor treatment was associated with patient outcomes. In conclusion, in this cohort of patients with submassive and massive PE, clot location was associated with treatment patterns but not patient outcomes to 90 days. Reevaluation of practice is thus warranted.
Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: cjain@partners.org.
C Charles
CC
Jain
Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
Yuchiao
Y
Chang
Department of Emergency Medicine, Center for Vascular Emergencies, Massachusetts General Hospital, Boston, Massachusetts.
Christopher
C
Kabrhel
Cardiovascular Medicine Division, University of Pennsylvania, Philadelphia, Pennsylvania.
Jay
J
Giri
Pulmonology Division, Massachusetts General Hospital, Boston, Massachusetts.
Richard
R
Channick
Pulmonology Division, Massachusetts General Hospital, Boston, Massachusetts.
Josanna
J
Rodriguez-Lopez
Hematology and Oncology Division, Massachusetts General Hospital, Boston, Massachusetts.
Rachel P
RP
Rosovsky
Hematology and Oncology Division, Massachusetts General Hospital, Boston, Massachusetts.
Annemarie
A
Fogerty
The Cardiology Division, The Fireman Vascular Center, Massachusetts General Hospital, Boston, Massachusetts.
Kenneth
K
Rosenfield
The Cardiology Division, The Fireman Vascular Center, Massachusetts General Hospital, Boston, Massachusetts.
Michael R
MR
Jaff
The Cardiology Division, The Fireman Vascular Center, Massachusetts General Hospital, Boston, Massachusetts.
Ido
I
Weinberg
D000368:Aged; D000072226:Computed Tomography Angiography; D016208:Databases, Factual; D004452:Echocardiography; D017128:Embolectomy; D005260:Female; D006801:Humans; D007022:Hypotension / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D016017:Odds Ratio; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016306:Vena Cava Filters; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000453:epidemiology*