Patients with unknown risk – with no cardiac marker or echocardiogram assessments – had higher mortality than patients with low-risk or submassive PE.

Acute pulmonary embolism (PE) is a high-risk clinical condition, with some subsets of patients having much greater risk for dying. In a prospective cohort (2018 to 2021), Italian investigators evaluated outcomes of 5200 patients with acute symptomatic PE at 182 hospitals. Most patients were stratified into low-risk PE (no evidence of right ventricular [RV] dysfunction), submassive PE (haemodynamically stable, but with RV dysfunction identified by high troponin level or high brain natriuretic peptide [BNP] level, or by echocardiogram) and massive PE (shock or cardiac arrest). However, 5% of patients had no laboratory or echocardiogram evaluation for RV function.

In-hospital mortality was 3.4%, and 30-day mortality was 4.8%. Among low-risk, submassive and massive PE, in-hospital mortality (0.9%, 3.4% and 20%, respectively) and 30-day mortality (1.7%, 5.0% and 23%, respectively) varied significantly. Patients with unknown risk (i.e. those without any cardiac markers or echocardiogram studies performed) had significantly higher inpatient and 30-day mortality (5% and 7%, respectively) than did patients with low-risk or submassive PE. 

Comment: Patients with acute PE and RV dysfunction – identified either by elevated laboratory markers or echocardiogram – have higher mortality risk than patients without RV dysfunction. Patients who had no evaluation for RV dysfunction, presumably because they were thought to be at low risk, actually were more likely to die than were patients with submassive PE. Therefore, all patients admitted with acute symptomatic PE deserve evaluation for RV dysfunction – either with troponin or BNP levels or echocardiogram – during hospitalisation.

Daniel D. Dressler, MD, MSc, MHM, FACP, Professor of Medicine, Emory University School of Medicine, Atlanta, USA.

Becattini C, et al. Contemporary management and clinical course of acute pulmonary embolism: the COPE study. Thromb Haemost 2023 Mar 20; e-pub (https://doi.org/10.1055/a-2031-3859).

This summary is taken from the following Journal Watch titles: General Medicine, Hospital Medicine.