Factors Associated with One-year Mortality in Patients with Acute Pulmonary Embolism

Introduction: Pulmonary embolism (PE) is the most common cause of vascular death after myocardial infarction and stroke, being associated with high mortality and morbidity rates. The aim of this study was to assess the factors related to 1-year mortality in patients with acute pulmonary embolism who survived the acute event. Material and methods: In total, 104 patients who had survived the acute episode of pulmonary embolism and underwent a one-month follow-up after the acute event were included in the study. The patients were divided into two groups: Group 1 – patients who had survived at one year after being diagnosed with acute PE (80.76%, n = 84), and Group 2 – patients who had died after one year (19.23%, n = 20). Results: There were no differences between the 2 groups in relation to gender (p = 0.3), or cardiovascular risk factors (diabetes: p = 0.5, smoking: p = 0.3, hypertension: p = 1, hypercholesterolemia: p = 0.5, hypertriglyceridemia: p = 0.4). Patients who had deceased were significantly older (73.35 ± 9.37 years vs. 66.36 ± 11.17 years, p = 0.005) and had a higher weight compared to the survivors (85.8 ± 21.09 kg vs. 75.89 ± 22.69 kg, p = 0.03). Left ventricular ejection fraction, measured by cardiac ultrasound, was significantly lower in the deceased group compared to survivors (45.63 ± 8.9% vs. 52.86 ± 6.8%, p = 0.03). Multivariate analysis identified the hemodynamic instability (OR = 3.17, p = 0.007), the presence of left QRS axis deviation (OR = 4.81, p = 0.001), associated pulmonary pathologies (OR = 3.2, p = 0.02) as well as the presence of chronic kidney disease (OR = 5, p = 0.04) as the most powerful predictors of death at 1 year in patients with acute PE surviving the acute event. Conclusions: Factors associated with a higher mortality rate at 1 year in patients who had survived at 1 month following an acute pulmonary embolism episode included: older age, higher body weight, presence of associated pulmonary pathologies, chronic kidney disease, left axis deviation, low left ventricular ejection fraction, hemodynamic instability requiring inotropic support, cardiogenic shock at presentation or cardiac arrest during the acute phase.