Clinical outcome of patients with suspected pulmonary embolism. A follow-up study of 588 consecutive patients

Objective. To investigate the clinical outcome in patients with clinically suspected pulmonary embolism (PE). Design and setting. In a retrospective design we studied 588 consecutive patients with suspected PE and referred for lung scintigraphy from 1995 to 1998. The mean follow-up time was 653 +/- 424 days. Results. The diagnosis of PE was confirmed in 194 and excluded in 394 patients, respectively. The overall prevalence of PE was 33%. Amongst clinical and paraclinical variables, age, chronic obstructive pulmonary disease (COPD), heart rate, pleuretic pain, presence of deep venous thrombosis (DVT), electrocardiographic signs of right ventricular (RV) strain were identified as independent predictors of the diagnosis of PE. Amongst patients with PE anticoagulation was given in 96% for at least 3 months and 13% received thrombolytic therapy. Recurrent PE was seen in 6% of patients with PE whereas none of the patients with no diagnosis of PE suffered PE during follow-up. The 1 year mortality was 18% amongst patients with PE and 15% in patients with excluded PE (P = NS). The cause of death amongst patients with PE was cancer (49%) and PE (28%), whereas patients without PE had an excess mortality because of cancer, COPD, acute myocardial infarction and heart failure. Conclusion. Patients admitted to hospital on suspicion of PE have increased risk of adverse clinical outcome whether the diagnosis of PE is confirmed or not. This indicates that the patients where the diagnosis is excluded often suffer from other serious illness that warrants further investigations.