Pre-existing pulmonary hypertension in acute pulmonary embolism was associated with higher in-hospital mortality than no pulmonary hypertension (4% vs 3%; aOR 1.12, 95% CI 1.03-1.21, p<0.007).
Observational (n=752,300)
Yes
Does pre-existing pulmonary hypertension worsen in-hospital outcomes in patients admitted with acute pulmonary embolism?
Pre-existing pulmonary hypertension in patients with acute pulmonary embolism is associated with increased in-hospital mortality, length of stay, healthcare costs, and cardiogenic shock.
Effect estimate: aOR 1.12 (95% CI 1.03-1.21)
Absolute Event Rate: 4% vs 3%
p-value: p=<0.007
Abstract Background Pulmonary hypertension (PH) is characterized by chronic pulmonary vascular remodeling and right ventricular dysfunction. It is defined as a mean pulmonary arterial pressure (mPAP) 20 mmHg at rest. Acute pulmonary embolism (APE) is the third most common cardiovascular (CV) disease, with an incidence of up to 115 per 100, 000 annually, and its clinical course may be influenced by PH. Prior studies were limited by a single-center design and small sample sizes. Understanding APE outcomes in PH patients is critical for risk stratification, early detection of decompensation, and guiding further management. This study used the National Inpatient Sample (NIS) to assess the relationship between pre-existing PH and inpatient outcomes among adults hospitalized with APE on a national scale. Methods Using the NIS Database from 2019-2022, we conducted a retrospective analysis of patients who were admitted with APE, using the respective ICD-10 codes. Patients were divided into two groups: those with PH and those without. Using both univariate and multivariate analyses, we compared the odds of various in-hospital outcomes, adjusted for confounders. Results There were 752300 admissions for APE, out of which 98625 (13. 1%) had PH. The primary outcome of interest was in-hospital mortality. Secondary outcomes included length of stay (LOS), total charges (TOTCHG), cardiogenic shock (CS), mechanical ventilation (MV), ECMO, cardiac arrest (CA), thrombolytic use, and acute right heart failure (ARHF). There was higher mortality in the PH group compared to the non-PH group (0. 04 vs 0. 03 adjusted odds ratio (aOR): 1. 12, CI: 1. 03-1. 21, p 0. 007). Regarding secondary outcomes, there were increased TOTCHG (80998 vs 56616, coefficient CoE: 21202 CI: 19567 - 22840, p 0. 001), mean LOS (5. 6 days vs 4. 3 days, CoE 1. 07, CI: 0. 99 - 1. 15, p 0. 001), CS (0. 03 vs 0. 01, aOR: 1. 84, CI: 1. 67-2. 03, P 0. 001), MV (0. 04 vs 0. 03 aOR: 0. 85, CI 0. 77-0. 93, p0. 001), CA (0. 02 vs 0. 02 aOR: 0. 76, CI: 0. 67-0. 87, p0. 001), ECMO (0. 03 vs 0. 02 aOR: 1. 30, CI: 0. 917-1. 85, p0. 139), Thrombolytic use (0. 13 vs 0. 06 aOR: 2. 28, CI: 2. 16-2. 40, p0. 001), ARHF (0. 05 vs 0. 01 aOR: 3. 31, CI: 2. 99-3. 67, p0. 001). Conclusion Patients with pre-existing PH who develop APE experience higher in-hospital mortality rates, longer LOS, and higher healthcare costs. They also have a higher risk of developing ARHF, CS, and the need for thrombolytic therapy. Nevertheless, lower rates of cardiac arrest and mechanical ventilation among PH patients suggest potential differences in code status or management. These results indicate the importance of early detection and individualized strategies for this population at high risk. This abstract is funded by: None
Taha et al. (Fri,) conducted a observational in Acute pulmonary embolism (n=752,300). Pre-existing pulmonary hypertension vs. No pulmonary hypertension was evaluated on In-hospital mortality (aOR 1.12, 95% CI 1.03-1.21, p=<0.007). Pre-existing pulmonary hypertension in acute pulmonary embolism was associated with higher in-hospital mortality than no pulmonary hypertension (4% vs 3%; aOR 1.12, 95% CI 1.03-1.21, p<0.007).