Abstract 12630: Comparison of Clinical and Imaging Characteristics and Outcome Between Provoked and Unprovoked Acute Pulmonary Thromboembolism
Objective: Pulmonary thromboembolism (PTE) in the absence of risk factors is classified as unprovoked or spontaneous PTE. We compared the clinical and imaging characteristics and prognosis of unprovoked versus provoked PTE.
Methods: Three hundred consecutive patients hospitalized with acute PTE at a single center from 1998 to 2008 were included. Patients were classified into 2 groups, provoked and unprovoked, based on whether the patients had risk factors for PTE. We compared clinical characteristics (age, sex, body mass index, hypertension, diabetes, history of coronary artery disease (CAD) or cerebrovascular accident (CVA), creatinine, cholesterol, triglyceride, C-reactive protein (CRP), B-type natriuretic peptide, D-dimer, shock on admission), imaging parameters (CT and echocardiography), and survival between groups. Prognostic factors of composite endpoint (death and recurrence) were analyzed by univariate and multivariate analysis.
Results: Mean age was 63.6 ± 15.0 years; 42.8% were male. There were 168 (56%) and 132 (44%) patients in the provoked and unprovoked groups, respectively. Mean follow-up period was 25.4 months. The unprovoked group had significantly more frequent smokers (p = 0.012) and history of CAD (p = 0.001), and a less frequent history of CVA (p = 0.001) compared to the provoked group. The unprovoked group had significantly better survival (p = 0.001) than the provoked group, including the subgroup of noncancer provoked patients (p= 0.006). Prognostic factors of composite endpoint in the unprovoked group were higher creatinine (> 1.2 mg/dL; p = 0.001; hazard ratio (HR), 4.735; 95% confidence interval (CI), 1.845-12.152), CRP (> 5 mg/L; p = 0.002; HR, 5.308; 95% CI, 1.824-15.447), and CT obstruction index (p = 0.034; HR, 1.090; 95% CI, 1.006-1.181).
Conclusions: Unprovoked PTE had a better prognosis than provoked PTE. Significant prognostic factors in unprovoked PTE were renal insufficiency, high CRP, and CT obstruction index.
- © 2011 by American Heart Association, Inc.