Characteristics and outcomes of acute pulmonary embolism among patients with polyvascular, single-vascular or no atherosclerotic disease: insights from RIETE

BACKGROUND: The role of atherosclerosis in pulmonary embolism (PE) prognosis remains uncertain. Our study assesses characteristics and outcomes of acute PE patients according to the presence and extent of atherosclerotic disease. METHODS: Using data from the RIETE registry, acute PE patients were classified into three groups based on personal history: (1) polyvascular atherosclerosis, (2) single vascular atherosclerosis, and (3) no symptomatic atherosclerosis. Primary outcomes included recurrent PE and venous thromboembolism (VTE), arterial events, major bleeding, and all-cause death. Hazard ratios (HR) and Kaplan-Meier curves for clinical outcomes were estimated using Cox regression models. RESULTS: Among 47,578 acute PE patients, 1,040 had polyvascular, 6,191 single-vascular, and 40,347 no atherosclerosis. During a median follow-up of 331 days, Adverse outcomes were more frequent in patients with atherosclerosis (vs. no atherosclerosis), rising with the number of affected vascular territories. Recurrent PE rates were 2.8, 1.6, and 1.2 per 100 patient-years in the polyvascular, single-vascular, and no atherosclerosis groups. Multivariable analysis showed a dose-dependent relationship between atherosclerosis and recurrent PE risk, with HRs of 3.2 (95% CI 1.7-5.9) and 1.6 (95% CI 1.1-2.3) for polyvascular and single-vascular disease (vs. no atherosclerosis). The risk of all-cause death followed a similar trend, with HRs of 1.3 (95% CI 1.1-1.6) and 1.2 (95% CI 1.1-1.4), respectively. Major bleeding appeared to be influenced by overall health status and antithrombotic therapy intensity. CONCLUSION: Atherosclerosis in acute PE patients may serve as a marker of disease severity and lead independently to adverse outcomes, highlighting the importance of cardiovascular risk stratification.