Abstract 11885: Prognostic Value at 6 Months of Discharge RPVO in Intermediate- to High-Risk Pulmonary Embolism
Aim: We aimed to evaluate the prognostic value at 6 months of residual pulmonary vascular obstruction (RPVO) measured before hospital discharge in pts with intermediate- or high-risk PE.
Methods: 416 consecutive pts with intermediate- or high-risk PE who survived the acute phase were included in a prospective registry. Pts with known chronic obstructive pulmonary disease or heart failure were excluded. Perfusion lung scans were performed within 6-8 days after onset of treatment. RVPO was graded as the proportion of lung not perfused. Primary objective was a combined endpoint at 6 months, including death, recurrent PE, appearance of signs of heart failure.
Results: At 6 months, 32 patients (7.7%) had ≥1 adverse events: 15 deaths (3.6%), 12 recurrent PE (2.9%), 14 cases (3.4%) of heart failure. Independent predictors of combined endpoint were: cancer (odds ratio (OR) 4.51 [1.63-12.5]); presence of >=1 risk factor for venous thrombo-embolic disease (OR 4.42 [1.53-12.8]); renal insufficiency at admission (OR 2.91 [1.16-7.27]); persistent ECG signs of cor pulmonale (OR 3.2 [1.11-9.24]); and persistent echocardiographic signs of RV dysfunction (OR 4.99 [1.46-16.31]). Severity of RPVO at discharge was also significantly associated with unfavorable outcome (OR 2.56 [1.69-3.87]). The incremental prognostic value of the RVPO information was confirmed by the decrease in the Akaike criterion, and the increases in indices of calibration (Hosmer-Lemeshow p value) and of discrimination (C-statistics) when RVPO was added to the multivariate model. The threshold RVPO value for predicting adverse events was estimated at 35% (area under the ROC curve = 0.76 [0.73-0.82]). Pts with RVPO above this threshold at discharge had a significantly higher risk of death at 6 months (p=0.01).
Conclusion: RPVO evaluated before hospital discharge in pts with intermediate- to high-risk PE is a powerful prognostic factor for outcome at 6 months. RPVO ≥35% is associated with an increased risk of adverse events at 6 months. External validation of this prognostic model is required in a large prospective study.
- © 2011 by American Heart Association, Inc.