Chest
Original Research: Venous Thromboembolic DiseaseClinical Syndromes and Clinical Outcome in Patients With Pulmonary Embolism: Findings From the RIETE Registry
Section snippets
Inclusion and Exclusion Criteria
Patients with symptomatic, acute DVT or PE confirmed by objective tests (ie, contrast venography, ultrasonography, or impedance plethysmography for suspected DVT; pulmonary angiography, lung scintigraphy, or helical CT scan for suspected PE) were consecutively enrolled in RIETE. Patients were excluded if they were participating in a therapeutic clinical trial or were unavailable for follow-up. All patients provided oral consent to their participation in the registry, in accordance with the
Results
As of January 2005, 4,145 patients with acute, symptomatic, objectively confirmed PE were enrolled in RIETE. Of them, 3,391 patients (82%) had no chronic lung disease or heart failure: 1,709 patients (50%) had pulmonary infarction, 1,083 patients (32%) had isolated dyspnea, and 599 patients (18%) had circulatory collapse. PE diagnosis was confirmed in 1,965 patients with positive CT scan results, 1,402 patients with high-probability V/Q lung scan results, 12 patients with visualization of a
Discussion
Our data, obtained from a large prospective series of consecutive patients with acute, symptomatic PE, confirm that their clinical presentation on hospital admission may have prognostic value. Indeed, the 6.2% and 6.5% mortality rates during the first 15 days of therapy in patients who presented with isolated dyspnea or circulatory collapse, respectively, clearly outweighed the 2.5% mortality rate in those with pulmonary infarction, who represented 50% of the whole series. These differences may
Members of the RIETE Group
Spain: Arcelus J.I.; Barba R.; Barrón M.; Beato J.L.; Blanco A.; Bugés J.; Cabezudo M.A.; Casado I.; Conget F.; De las Heras G.; Falgá C.; Fernández-Capitán C.; Gallego P.; García-Bargado F.; Grau E.; Guijarro R.; Guil M.; Gutiérrez J.; Hernández L.; Jiménez D.; Laserna E.; Lecumberri R.; Lobo J.L..; López F.; López L.; López I.; Maestre A.; Martín J.J.; Monreal M.; Montes J.; Naufall M.D.; Nieto J.A.; Núñez M.J.; Orue M.T.; Otero R.; Pedrajas J.M.; Portillo J.; Rabuñal R.; Raguer E.; Raventós
ACKNOWLEDGMENT
We express our gratitude to the Registry Coordinating Center, S & H Medical Science Service, for their logistic and administrative support.
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Cited by (69)
Pulmonary infarction in acute pulmonary embolism
2021, Thrombosis ResearchCitation Excerpt :Several studies assessed the mortality in PE patients with infarction. In pulmonary infarction as a clinical syndrome, a lower in-hospital mortality (0% in pulmonary infarction vs. 25% in circulatory collapse and 14% in isolated dyspnea) (67) and 15-day mortality (2.5% in pulmonary infarction vs. 6.2% in circulatory collapse and 6.7% in isolated dyspnea) (34) were shown as compared to other clinical PE syndromes. As the clinical syndrome is based on pleuritic chest pain and hemoptysis, it is thought that these patients present earlier to medical care, and reflect smaller, more peripheral emboli, explaining the lower mortality.
Epidemiology, patterns of care and mortality for patients with hemodynamically unstable acute symptomatic pulmonary embolism
2018, International Journal of CardiologyClinical relevance of syncope in patients with pulmonary embolism
2018, Thrombosis ResearchCitation Excerpt :The common symptoms of PE include dyspnea, chest pain, and hemoptysis [2], and syncope is an unusual clinical manifestation associated with this condition. Syncope has been reported to occur in 5.5–16% of patients with PE, depending upon the study design and the population in which these findings were noted [2–11]. Data regarding the incidence of syncope in Asian patients with PE are lacking.
The prognostic impact of chest pain in 1306 patients presenting with confirmed acute pulmonary embolism
2016, International Journal of CardiologyCitation Excerpt :It has been hypothesised that occlusion of smaller, peripheral pulmonary arteries more frequently lead to pulmonary infarction due to inability of the smaller pulmonary arterial bed to accommodate systemic arterial inflow from bronchial anastomoses, resulting in extravasation of red blood cells into the alveoli and subsequent infarction [10]. However, whether pulmonary infarction carries independent prognostic value has been disputed amongst different studies [11,12]. More specifically, the prognostic significance of the symptom of chest pain in acute PE has never been defined.
Right bundle branch block and S<inf>I</inf>Q<inf>III</inf>-type patterns for risk stratification in acute pulmonary embolism
2016, Journal of ElectrocardiologySyncope and collapse in acute pulmonary embolism
2016, American Journal of Emergency Medicine
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).
Drs. Lobo, Zorrilla, Aizpuru, Uresandi, Conget, Garcia-Bragado, and Monreal have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
RIETE was supported by an unrestricted educational grant from Sanofi-Aventis.
This project has been partially supported by Red Respira, Instituto Carlos III (RedRespira-ISCiii-RTIC-03/11).