Severity of pulmonary embolism at initial diagnosis and long-term clinical outcomes: From the COMMAND VTE Registry. (15th November 2021)

• Record Type: Journal Article
• Authors: Yamashita, Yugo; Morimoto, Takeshi; Kadota, Kazushige; Takase, Toru; Hiramori, Seiichi; Kim, Kitae; Oi, Maki; Akao, Masaharu; Kobayashi, Yohei; Toyofuku, Mamoru; Inoko, Moriaki; Tada, Tomohisa; Izumi, Toshiaki; Chen, Po-Min; Murata, Koichiro; Tsuyuki, Yoshiaki; Nishimoto, Yuji; Sasa, Tomoki; Sakamoto, Jiro; Kinoshita, Minako; Togi, Kiyonori; Mabuchi, Hiroshi; Takabayashi, Kensuke; Kato, Takao; Ono, Koh; Kimura, Takeshi
• Is Part Of: International journal of cardiology. Volume 343(2021)
• Page Start: 107
• Page End: 113
• Publication Date: 2021-11-15
• Subjects: Pulmonary embolism -- Severity -- Recurrence -- Bleeding -- Mortality; AHA American Heart Association; -- BNP brain natriuretic peptide -- CI confidence interval -- DVT deep vein thrombosis -- HR hazard ratio -- INR international normalized ratio -- IQR interquartile range -- ISTH International Society of Thrombosis and Hemostasis -- PE pulmonary embolism -- RV right ventricular -- TTR time in therapeutic range -- VTE venous thromboembolism; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2021.08.052
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: There is a paucity of data on the long-term clinical outcomes according to the severity of pulmonary embolism (PE) at initial diagnosis. Methods: The COMMAND VTE Registry is a multicenter registry enrolling 3027 consecutive patients with acute symptomatic venous thromboembolism (VTE). After excluding 1312 patients without PE, the current study population consisted of 1715 patients with PE, who were divided into 3 groups according to the clinical severity; massive PE, sub-massive PE and low-risk PE. Results: There were 179 patients (10%) with massive PE, 742 patients (43%) with sub-massive PE, and 794 patients (46%) with low-risk PE. By the landmark analysis at 3 months, the cumulative incidences of recurrent VTE were similar among the 3 groups both within and beyond 3 months (Massive PE: 2.9%, Sub-massive PE: 4.2%, and Low-risk PE: 3.3%, P = 0.61, and 4.3%, 8.8%, and 7.8% at 5 years, P = 0.47, respectively). After adjusting confounders, the risk of massive PE relative to low-risk PE for recurrent VTE beyond 3 months remained insignificant (adjusted HR 0.54, 95% CI: 0.13–1.51, P = 0.27). Patients with massive PE at initial diagnosis more often presented as severe recurrent PE events than those with sub-massive and low-risk PE. Conclusions: In the current real-world large registry, the long-term risk of overall recurrent VTE in patients with massive PE at initial diagnosis did not significantly differ from those with sub-massive and low-risk PE beyond 3 months, although patients with massive PE at initial diagnosis more frequently developed recurrent VTE as PE with severe clinical presentation. Highlights: The long-term recurrent risk was comparable depending on PE severity at diagnosis. Massive PE more often developed recurrent VTE as severe PE events. The long-term risks of major bleeding and all-cause death was comparable.