Outcome of patients with different clinical presentations of high-risk pulmonary embolism

被引:16
作者
Ebner, Matthias [1 ,2 ]
Sentler, Carmen [3 ]
Harjola, Veli-Pekka [4 ]
Bueno, Hector [5 ,6 ,7 ,8 ]
Lerchbaumer, Markus H. [9 ]
Hasenfuss, Gerd [3 ,10 ]
Eckardt, Kai-Uwe [11 ]
Konstantinides, Stavros, V [12 ,13 ]
Lankeit, Mareike [2 ,3 ,12 ,14 ]
机构
[1] Charite Univ Med Berlin, Dept Cardiol & Angiol, Campus Charite Mitte CCM, Berlin, Germany
[2] German Ctr Cardiovasc Res DZHK, Partner Site Berlin, Berlin, Germany
[3] Univ Med Ctr, Clin Cardiol & Pneumol, Gottingen, Germany
[4] Univ Helsinki, Helsinki Univ Hosp, Dept Emergency Med & Serv, Emergency Med, Helsinki, Finland
[5] Ctr Nacl Invest Cardiovasc CNIC, Madrid, Spain
[6] Hosp Univ 12 Octubre, Cardiol Dept, Madrid, Spain
[7] 12 Octubre imas12, Inst Invest Sanitaria Hosp, Madrid, Spain
[8] Univ Complutense Madrid, Fac Med, Madrid, Spain
[9] Charite Univ Med Berlin, Dept Radiol, Campus Charite Mitte CCM, Berlin, Germany
[10] German Ctr Cardiovasc Res DZHK, Partner Site Gottingen, Gottingen, Germany
[11] Charite Univ Med Berlin, Dept Nephrol & Med Intens Care, Berlin, Germany
[12] Univ Med Ctr Mainz, Ctr Thrombosis & Hemostasis CTH, Mainz, Germany
[13] Democritus Univ Thrace, Dept Cardiol, Alexandroupolis, Greece
[14] Charite Univ Med Berlin, Dept Internal Med & Cardiol, Campus Virchow Klinikum CVK, Augustenburger Pl 1, D-13353 Berlin, Germany
关键词
Pulmonary embolism; High risk; Lactate; Obstructive shock; Prognosis; PLASMA LACTATE LEVELS; EUROPEAN-SOCIETY; TASK-FORCE; MANAGEMENT; THROMBOEMBOLISM; STRATIFICATION; GUIDELINES; DIAGNOSIS; MORTALITY; TRENDS;
D O I
10.1093/ehjacc/zuab038
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims The 2019 European Society of Cardiology (ESC) guidelines provide a revised definition of high-risk pulmonary embolism (PE) encompassing three clinical presentations: Cardiac arrest, obstructive shock, and persistent hypotension. This study investigated the prognostic implications of this new definition. Methods and results Data from 784 consecutive PE patients prospectively enrolled in a single-centre registry were analysed. Study outcomes include an in-hospital adverse outcome (PE-related death or cardiopulmonary resuscitation) and in-hospital all-cause mortality. Overall, 86 patients (11.0%) presented with high-risk PE and more often had an adverse outcome (43.0%) compared to intermediate-high-risk patients (6.1%; P<0.001). Patients with cardiac arrest had the highest rate of an in-hospital adverse outcome (78.4%) and mortality (59.5%; both P<0.001 compared to intermediate-high-risk patients). Obstructive shock and persistent hypotension had similar rates of adverse outcomes (15.8% and 18.2%, respectively; P=0.46), but the only obstructive shock was associated with an increased all-cause mortality risk. Use of an optimised venous lactate cut-off value (3.8mmol/L) to diagnose obstructive shock allowed differentiation of adverse outcome risk between patients with shock (21.4%) and persistent hypotension (9.5%), resulting in a net reclassification improvement (0.240.08; P=0.002). Conclusion The revised ESC 2019 guidelines definition of high-risk PE stratifies subgroups at different risk of in-hospital adverse outcomes and all-cause mortality. Risk prediction can be improved by using an optimised venous lactate cut-off value to diagnose obstructive shock, which might help to better assess the risk-to-benefit ratio of systemic thrombolysis in different subgroups of high-risk patients.
引用
收藏
页码:787 / 796
页数:10
相关论文
共 24 条
[1]   Acute pulmonary embolism: mortality prediction by the 2014 European Society of Cardiology risk stratification model [J].
Becattini, Cecilia ;
Agnelli, Giancarlo ;
Lankeit, Mareike ;
Masotti, Luca ;
Pruszczyk, Piotr ;
Casazza, Franco ;
Vanni, Simone ;
Nitti, Cinzia ;
Kamphuisen, Pieter ;
Vedovati, Maria Cristina ;
De Natale, Maria Grazia ;
Konstantinides, Stavros .
EUROPEAN RESPIRATORY JOURNAL, 2016, 48 (03) :780-786
[2]   Temporal trends in management and outcome of pulmonary embolism: a single-centre experience [J].
Ebner, Matthias ;
Kresoja, Karl-Patrik ;
Keller, Karsten ;
Hobohm, Lukas ;
Rogge, Nina I. J. ;
Hasenfuss, Gerd ;
Pieske, Burkert ;
Konstantinides, Stavros V. ;
Lankeit, Mareike .
CLINICAL RESEARCH IN CARDIOLOGY, 2020, 109 (01) :67-77
[3]   Prognostic impact of copeptin in pulmonary embolism: a multicentre validation study [J].
Hellenkamp, Kristian ;
Pruszczyk, Piotr ;
Jimenez, David ;
Wyzgal, Anna ;
Barrios, Deisy ;
Ciurzynski, Michal ;
Morillo, Raquel ;
Hobohm, Lukas ;
Keller, Karsten ;
Kurnicka, Katarzyna ;
Kostrubiec, Maciej ;
Wachter, Rolf ;
Hasenfuss, Gerd ;
Konstantinides, Stavros ;
Lankeit, Mareike .
EUROPEAN RESPIRATORY JOURNAL, 2018, 51 (04)
[4]   Risk stratification of normotensive pulmonary embolism: prognostic impact of copeptin [J].
Hellenkamp, Kristian ;
Schwung, Johanna ;
Rossmann, Heidi ;
Kaeberich, Anja ;
Wachter, Rolf ;
Hasenfuss, Gerd ;
Konstantinides, Stavros ;
Lankeit, Mareike .
EUROPEAN RESPIRATORY JOURNAL, 2015, 46 (06) :1701-1710
[5]   Trends in the Management and Outcomes of Acute Pulmonary Embolism Analysis From the RIETE Registry [J].
Jimenez, David ;
de Miguel-Diez, Javier ;
Guijarro, Ricardo ;
Trujillo-Santos, Javier ;
Otero, Remedios ;
Barba, Raquel ;
Muriel, Alfonso ;
Meyer, Guy ;
Yusen, Roger D. ;
Monreal, Manuel .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2016, 67 (02) :162-170
[6]   Management strategies and determinants of outcome in acute major pulmonary embolism: Results of a multicenter registry [J].
Kasper, W ;
Konstantinides, S ;
Geibel, A ;
Olschewski, M ;
Heinrich, F ;
Grosser, KD ;
Rauber, K ;
Iversen, S ;
Redecker, M ;
Kienast, J .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1997, 30 (05) :1165-1171
[7]   Trends in thrombolytic treatment and outcomes of acute pulmonary embolism in Germany [J].
Keller, Karsten ;
Hobohm, Lukas ;
Ebner, Matthias ;
Kresoja, Karl-Patrik ;
Muenzel, Thomas ;
Konstantinides, Stavros, V ;
Lankeit, Mareike .
EUROPEAN HEART JOURNAL, 2020, 41 (04) :522-529
[8]  
Konstantinides SV, 2019, EUR RESPIR J, V54, DOI [10.1183/13993003.01647-2019, 10.1093/eurheartj/ehz405]
[9]   2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) [J].
Konstantinides, Stavros V. ;
Torbicki, Adam ;
Agnelli, Giancarlo ;
Danchin, Nicolas ;
Fitzmaurice, David ;
Galie, Nazzareno ;
Gibbs, J. Simon R. ;
Huisman, Menno V. ;
Humbert, Marc ;
Kucher, Nils ;
Lang, Irene ;
Lankeit, Mareike ;
Lekakis, John ;
Maack, Christoph ;
Mayer, Eckhard ;
Meneveau, Nicolas ;
Perrier, Arnaud ;
Pruszczyk, Piotr ;
Rasmussen, Lars H. ;
Schindler, Thomas H. ;
Svitil, Pavel ;
Noordegraaf, Anton Vonk ;
Zamorano, Jose Luis ;
Zompatori, Maurizio .
EUROPEAN HEART JOURNAL, 2014, 35 (43) :3033-3080
[10]   Pulmonary embolism as cause of cardiac arrest -: Presentation and outcome [J].
Kürkciyan, I ;
Meron, G ;
Sterz, F ;
Janata, K ;
Domanovits, H ;
Holzer, M ;
Berzlanovich, A ;
Bankl, HC ;
Laggner, AN .
ARCHIVES OF INTERNAL MEDICINE, 2000, 160 (10) :1529-1535