Differences in risk factors between all-cause and pulmonary embolism-related death in acute pulmonary embolism: insights from the COMMAND VTE registry-2

Background The accurate risk prediction of early mortality, particularly PE-related death, in patients with acute pulmonary embolism (PE) has become more important for selecting optimal management strategies. Objectives To evaluate the cumulative 30-day incidence of and risk factors for all-cause and PE-related death within 30 days. Patients/Methods In the COMMAND VTE Registry-2, which enrolled symptomatic patients with venous thromboembolism at 31 centers in Japan, we analyzed 2035 patients with acute PE. Results The cumulative 30-day incidence of all-cause and PE-related death were 6.4 and 3.4%, respectively. Independent risk factors for all-cause and PE-related death were age >80 years (HR, 2.43; 95%CI, 1.45–4.08; P <0.001), hypoxemia (HR, 3.36; 95%CI, 1.07–10.5; P =0.04), tachycardia (HR, 3.78; 95%CI, 2.20–6.50; P <0.001), hypotension (HR, 5.43; 95% CI, 3.17–9.29; P <0.001), an abnormal leukocyte count (HR, 1.78; 95%CI, 1.08–2.93; P =0.02), and the absence of proximal deep vein thrombosis (HR, 2.58; 95%CI, 1.51–4.39; P <0.001). Active cancer (HR, 2.59; 95%CI, 1.75–3.82; P <0.001) and male sex (HR, 1.56; 95%CI, 1.07–2.28; P =0.02) were independent risk factors for all-cause death, but not PE-related death. Chronic heart or lung disease (HR, 1.72; 95%CI, 1.02–2.90; P =0.04) and right ventricular dysfunction (HR, 2.61; 95%CI, 1.02–6.70; P =0.046) were independent risk factors for PE-related death, but not all-cause death. Conclusions We identified several independent risk factors for PE-related death within 30 days, which differed from those for all-cause death. Risk factors specifically for PE-related death may be useful in decision-making for optimal treatment strategies for acute PE.