High-risk pulmonary embolism was associated with significantly higher in-hospital mortality than intermediate-risk PE (20.6% vs 3.7%; P<0.001), with catastrophic PE reaching 42.1% mortality.
Cohort (n=5,790)
Yes
High-risk pulmonary embolism is associated with substantial in-hospital mortality (20.6%), particularly in patients presenting with hemodynamic collapse (42.1%), highlighting the need for optimized management strategies in this critically ill population.
Absolute Event Rate: 20.6% vs 3.7%
p-value: p=<0.001
BACKGROUND Contemporary care patterns/outcomes in high-risk pulmonary embolism (PE) patients are unknown. OBJECTIVES This study sought to characterize the management of high-risk PE patients and identify factors associated with poor outcomes. METHODS A retrospective analysis of the PERT (Pulmonary Embolism Response Team) Consortium Registry was performed. Patients presenting with intermediate-risk PE, high-risk PE, and catastrophic PE (those with hemodynamic collapse) were identified. Patient characteristics were compared with chi-square testing for categorical covariates and Student’s t-test for continuous covariates. Multivariable logistic regression was used to assess associations between clinical characteristics and outcomes in the high-risk population. RESULTS Of 5,790 registry patients, 2,976 presented with intermediate-risk PE and 1,442 with high-risk PE. High-risk PE patients were more frequently treated with advanced therapies than intermediate-risk PE patients (41.9% vs 30.2%; P < 0.001). In-hospital mortality (20.6% vs 3.7%; P < 0.001) and major bleeding (10.5% vs. 3.5%; P < 0.001) were more common in high-risk PE. Multivariable regression analysis demonstrated vasopressor use (OR: 4.56; 95% CI: 3.27–6.38; P < 0.01), extracorporeal membrane oxygenation use (OR: 2.86; 95% CI: 1.12–7.30; P = 0.03), identified clot-in-transit (OR: 2.26; 95% CI: 1.13–4.52; P = 0.02), and malignancy (OR: = 1.70; 95% CI: 1.13–2.56; P = 0.01) as factors associated with in-hospital mortality. Catastrophic PE patients (n = 197 13.7% of high-risk PE patients) had higher in-hospital mortality (42.1% vs 17.2%; P < 0.001) than those presenting with noncatastrophic high-risk PE. Extracorporeal membrane oxygenation (13.3% vs. 4.8% P < 0.001) and systemic thrombolysis (25% vs 11.3%; P < 0.001) were used more commonly in catastrophic PE. CONCLUSIONS In the largest analysis of high-risk PE patients to date, mortality rates were high with the worst outcomes among patients with hemodynamic collapse.
“High-risk PE is classically defined by 'hemodynamic instability' based on persistently low arterial blood pressure or collapse, necessitating cardiopulmonary resuscitation. It is associated with a very unfavorable early prognosis, with in-hospital mortality rates ranging from 20% to 50%, and rising to almost 85% if cardiac arrest occurs. Of all patients with acute PE, these are the patients who most urgently need effective life-saving treatment, but this is also the PE risk class with the largest knowledge gaps regarding optimal management to date.”
Kobayashi et al. (Mon,) conducted a cohort in Pulmonary Embolism (n=5,790). High-risk pulmonary embolism vs. Intermediate-risk pulmonary embolism was evaluated on In-hospital mortality (p=<0.001). High-risk pulmonary embolism was associated with significantly higher in-hospital mortality than intermediate-risk PE (20.6% vs 3.7%; P<0.001), with catastrophic PE reaching 42.1% mortality.
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