Epidemiology and Outcomes of Acute Pulmonary Embolism in Seychelles: A National Cohort Study With a Subgroup Analysis of Systemic Thrombolysis Efficacy and Safety in Intermediate-Risk Pulmonary Embolism

Figures

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  Figure 1. Flowchart of patient screening, risk stratification, and group allocation

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  Figure 2. Correlation between annual incidence, mortality rate, and average length of stay of pulmonary embolism in Seychelles.

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  Figure 3. Overall age distribution of the thrombolysis group

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  Figure 4. Average changes in the physiological parameters before and after thrombolysis

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  Figure 5. Average changes in the echocardiography parameters before and after thrombolysis

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  Figure 6. Correlation between the number of thrombolyzed patients/year and mortality rate

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  Figure 7. Case 1: A. Axial chest CT scan with contrast shows saddle pulmonary embolism (orange arrow). B. ECG shows sinus tachycardia, S1Q3T3, and inverted T waves in different leads.

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  Figure 8. Case 2: A. Pre-thrombolysis CT scan with IV contrast axial plane shows saddle pulmonary embolism (green arrow), right (blue arrow), and left (orange arrow) pulmonary artery emboli. B. Pre-thrombolysis bedside echocardiography, apical four-chamber view showed dilated RV (blue arrow) dimensions. > left ventricle (LV) (orange arrow), basal RV: 56 mm. C. Post-thrombolysis CT scan with IV contrast shows complete resolution of the saddle and left pulmonary artery emboli with partial resolution of the right pulmonary artery embolus (blue arrow). D. Post-thrombolysis bedside echocardiography; apical four-chamber view showed normal RV (blue arrow). < LV dimension (orange arrow), RV basal dimension 33 mm.

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  Figure 9. Case 3: A. Pre-thrombolysis axial CT scan with contrast shows saddle pulmonary embolus detected at the bifurcation of the pulmonary artery (green arrow), extending to the right main pulmonary artery (blue arrow) and left pulmonary artery (orange arrow). B. Pre-thrombolysis ECG shows sinus tachycardia. C. Post-thrombolysis CT with contrast axial plane shows complete resolution of the saddle embolus with partially resorbed right main pulmonary artery (blue arrow) and left pulmonary artery (orange arrow). D. Post-thrombolysis ECG shows resolution of the tachycardia.

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  Figure 10. Case 4: A. Pre-thrombolysis axial CT scan with contrast shows bilateral pulmonary embolism occluding the right main pulmonary artery (blue arrow) and the left main pulmonary artery (orange arrows). B. Post-thrombolysis axial CT scan shows significant recanalization of the right main pulmonary artery (blue arrow) and the left pulmonary artery (orange arrow).

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  Figure 11. Case 5: A. Pre-thrombolysis axial CT angiogram shows bilateral pulmonary embolism, involving the right main pulmonary artery (blue arrow) and left main pulmonary artery (orange arrow). B. Pre-thrombolysis ECG shows borderline tachycardia. C. Post-thrombolysis axial CT angiogram shows resolved pulmonary embolism bilaterally. D. Post-thrombolysis ECG shows resolution of tachycardia, with persistent inverted T wave in anterior leads.

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  Figure 12. Case 6: A. Pre-thrombolysis chest CT angiogram shows the right main pulmonary artery thrombus (blue arrows). B. Pre-thrombolysis shows sinus tachycardia and incomplete right bundle branch block (RBBB). C. Post-thrombolysis chest CT angiogram shows minimal resolution of the right main pulmonary artery thrombus (blue arrow). D. Improved tachycardia with resolution of RBBB and persistent widespread T-wave abnormality.