Late Prognosis of Acute Pulmonary Embolism

Sixty consecutive patients who survived an episode of acute pulmonary embolism documented by pulmonary angiography were assessed one to seven years later (average follow-up period, 29 months) to determine long-term prognosis. Thirty-nine were alive, 19 (32 per cent) had died, and two were lost to follow-up study. Survival largely depended on cardiac status before embolism. Of 42 patients without left ventricular failure, 36 survived. However, of 16 with failure before embolism, only three survived. Follow-up lung scans and arterial-blood gases in the survivors and autopsy in those who died demonstrated resolution of embolism in most patients. Of 43 with adequate follow-up data, resolution was complete in 28 (65 per cent) and partial in 10 (23 per cent); unresolved embolism persisted in only five patients (12 per cent), with resultant chronic cor pulmonale in only one. Recurrent embolism was documented in only one. The long-term prognosis of patients who survive acute embolism thus appears to be dependent on the presence or absence of prior heart disease. (N Engl J Med 289:55–58, 1973)