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(Circulation. 2008;117:1711-1716.)
© 2008 American Heart Association, Inc.

Vascular Medicine

Clinical Predictors for Fatal Pulmonary Embolism in 15 520 Patients With Venous Thromboembolism

Findings From the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) Registry

Silvy Laporte, PhD; Patrick Mismetti, MD, PhD; Hervé Décousus, MD; Fernando Uresandi, MD, PhD; Remedios Otero, MD, PhD; Jose Luis Lobo, MD, PhD; Manuel Monreal, MD, PhD; the RIETE Investigators^*

From the Clinical Pharmacology Department, Thrombosis Research Group, EA 3065 (S.L., P.M., H.D.) and Department of Internal Medicine and Therapeutics (P.M.), University Hospital; and Inserm CIE3, F-42055 (H.D.), Saint-Etienne, France; Department of Pulmonology, Hospital de Cruces, Barakaldo, Vizcaya (F.U.), Department of Pulmonology, Hospital Virgen del Rocío, Sevilla (R.O.), Department of Pulmonology, Hospital Txagorritxu, Vitoria, Alava (J.L.L.), and Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona (M.M.), Spain.

Correspondence to Silvy Laporte, Clinical Pharmacology Department, Thrombosis Research Group, EA 3065, University Hospital of Saint-Etienne Bellevue, 42055 Saint-Etienne cedex 02, France. E-mail silvy.laporte{at}chu-st-etienne.fr

Received July 6, 2007; accepted January 28, 2008.

Background— Clinical predictors for fatal pulmonary embolism (PE) in patients with venous thromboembolism have never been studied.

Methods and Results— Using data from the international prospective Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) registry about patients with objectively confirmed symptomatic acute venous thromboembolism, we determined independent predictive factors for fatal PE. Between March 2001 and July 2006, 15 520 consecutive patients (mean age±SD, 66.3±16.9 years; 49.7% men) with acute venous thromboembolism were included. Symptomatic deep-vein thrombosis without symptomatic PE was observed in 58.0% (n=9008) of patients, symptomatic nonmassive PE in 40.4% (n=6264), and symptomatic massive PE in 1.6% (n=248). At 3 months, the cumulative rates of overall mortality and fatal PE were 8.65% and 1.68%, respectively. On multivariable analysis, patients with symptomatic nonmassive PE at presentation exhibited a 5.42-fold higher risk of fatal PE compared with patients with deep-vein thrombosis without symptomatic PE (P<0.001). The risk of fatal PE was multiplied by 17.5 in patients presenting with a symptomatic massive PE. Other clinical factors independently associated with an increased risk of fatal PE were immobilization for neurological disease, age >75 years, and cancer.

Conclusion— PE remains a potentially fatal disease. The clinical predictors identified in the present study should be included in any clinical risk stratification scheme to optimally adapt the treatment of PE to the risk of the fatal outcome.

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Clinical Summaries
Circulation 2008 117: 1621. [Extract] [Full Text]