Key result
High-risk pulmonary embolism was associated with a 53.9% in-ICU mortality rate compared to 2.4% for intermediate-high-risk pulmonary embolism.
Cohort (n=145)
No
High-risk PE carries a high in-ICU mortality, particularly when presenting with cardiac arrest, high lactates, or low subaortic VTI, whereas intermediate-high-risk PE has low mortality with anticoagulant-only treatment.
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Long-term PE prognosis data from this ICU cohort may refine risk models; leaves open thrombolysis benefit in intermediate-high risk.
Background: Mortality rate of pulmonary embolism (PE) at 3 months is over 15% for the high risk presentation and varies from 3% to 15% for the intermediate-risk presentation. Thrombolysis in intermediate-risk PE remains a matter of debate. Methods: We undertook a retrospective study over a 11-year period including patients with high and intermediatehigh- risk PE, hospitalised in a medical ICU in a University hospital, to assess medium and long-term prognosis. Results: Our series involved 145 patients, of whom 63 presented high risk PE and 82 had an intermediate-highrisk PE. Thirty-six patients (24.8%) died in the intensive care unit (ICU) including high-risk PE: 34/63 (53.9%), of whom 25 after inaugural cardiac arrest (CA); intermediate-high-risk PE: 2/82 (2.4%). On multivariate analysis, high blood lactates (OR: 1.88; IC 95% 1.18-3.02, p=0.0083), resuscitated CA (OR: 12.33; IC 95% 1.1-137.4, p=0.041), low subaortic velocity time integral (VTI) (OR: 9.22, IC 0.38-0.81, p=0.0024) were independent factors of in-ICU mortality. Twenty-seven patients died after ICU discharge. Echocardiographic checks were performed in 63 patients, in which 4 (6.3%) presented a chronic thromboembolic pulmonary hypertension (CTPH). Conclusion: High-risk PE still has a high mortality rate in the ICU especially when revealed by a cardiac arrest. High blood lactates, resuscitated CA, and low subaortic VTI were independent predictive factors of mortality. In our retrospective cohort, long-term prognosis was good with only 4 cases of CTPH. The low mortality observed with anticoagulant-only treatment do not encourage thrombolysis for management of intermediate-high-risk PE patients.
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Rougé et al. (2017) conducted a cohort in Pulmonary embolism with right ventricular dysfunction (n=145). High-risk pulmonary embolism vs. Intermediate-high-risk pulmonary embolism was evaluated on in-ICU mortality. High-risk pulmonary embolism was associated with a 53.9% in-ICU mortality rate compared to 2.4% for intermediate-high-risk pulmonary embolism.
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