Abstract 20840: Association between Biomarker, Computed Tomography and Echocardiography Results, and Five-Day Clinical Adverse Events after Pulmonary Embolism
Introduction: Patients with acute pulmonary embolism (PE) are at high risk for clinical adverse events (CAEs) in the days immediately following diagnosis. Biomarkers, radiographic and echocardiographic findings are associated with 30 day mortality and CAEs. However, whether these measures are associated with shorter term (5 day) CAEs is less well known.
Methods: Retrospective analysis of Emergency Department patients with PE from May 2006 to April 2008. We reviewed medical records for demographics, test results, and evidence of CAEs. PE was defined as a positive CTPA or high probability ventilation perfusion scan. Patients were considered to have a CAE if, within the first 5 days after PE diagnosis, they: A) had recurrent symptomatic PE; B) required advanced cardiac life support; C) had two systolic blood pressures <100mmHg; D) were treated with vasopressors; E) had an oxygen saturation <90% F) required >2L/min of oxygen; G) developed a cardiac arrhythmia; H) received thrombolysis /thrombectomy; I) returned to the hospital after discharge; J) died. We performed multivariable logistic regression model including demographics, vital signs, biomarkers (troponin, d-dimer, N-terminal-pro brain natriuretic peptide), number and location of filling defects on CTPA. A secondary model including right heart strain on echocardiography was also analyzed.
Results: We identified 250 patients with PE, of whom 244 had complete data, and 82 (33%) had a CAE. Mean age was 57.2±17 years, 118 (48%) were male, and 207 (83%) were Caucasian. On multivariable analysis, age (OR=1.03 [1.01–1.05], p=0.01), troponin ≥0.05ng/mL (OR=3.91 [1.27–11.99], p=0.02) and pulse ≥100 (OR=2.64 [1.28–5.43], p=0.01) were associated with CAEs. Elevated D-Dimer, NT-proBNP, and CTPA results were not associated. When echocardiographic findings were included in the model, only pulse ≥100 (OR=4.02 [1.06–15.23], p=0.04) and right heart strain (OR=5.71 [1.64–19.99], p<0.01) were associated.
Conclusions: Age, tachycardia and troponin elevation are associated with CAEs in the first 5 days after acute PE.
- © 2010 by American Heart Association, Inc.