Goldhaber S Z, Visani L, De Rosa M
Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
Lancet. 1999 Apr 24;353(9162):1386-9. doi: 10.1016/s0140-6736(98)07534-5.
Pulmonary embolism (PE) remains poorly understood. Rates of clinical outcomes such as death and recurrence vary widely among trials. We therefore established the International Cooperative Pulmonary Embolism Registry (ICOPER), with the aim of identifying factors associated with death.
2454 consecutive eligible patients with acute PE were registered from 52 hospitals in seven countries in Europe and North America. The primary outcome measure was all-cause mortality at 3 months. The prognostic effect of baseline factors on survival was assessed with multivariate analyses.
2110 (86.0%) patients had PE proven by necropsy, high-probability lung scan, pulmonary angiography, or venous ultrasonography plus high clinical suspicion; ICOPER accepted without independent review diagnoses and interpretation of imaging provided by participating centres; 3-month follow-up was completed in 98.0% of patients. The overall crude mortality rate at 3 months was 17.4% (426 of 2454 deaths, including 52 patients lost to follow-up): 179 of 397 (45.1%) deaths were ascribed to PE and 70 of 397 (17.6%) to cancer, and no information on the cause of death was available for 29 patients. After exclusion of 61 patients in whom PE was first discovered at necropsy, the mortality rate at 3 months was 15.3% (365 of 2393 deaths). On multiple-regression modelling, age over 70 years (hazard ratio 1.6 [95% CI 1.1-2.3]), cancer (2.3 [1.5-3.5]), congestive heart failure (2.4 [1.5-3.7]), chronic obstructive pulmonary disease (1.8 [1.2-2.7]), systolic arterial hypotension (2.9 [1.7-5.0]), tachypnoea (2.0 [1.2-3.2]), and right-ventricular hypokinesis on echocardiography (2.0 [1.3-2.9]) were identified as significant prognostic factors.
PE remains an important clinical problem with a high mortality rate. Data from ICOPER provide rates and highlight adverse prognostic categories that will help in planning of future trials of high-risk PE patients.
肺栓塞（PE）仍未被充分了解。在各项试验中，诸如死亡和复发等临床结局的发生率差异很大。因此，我们建立了国际合作肺栓塞注册研究（ICOPER），旨在确定与死亡相关的因素。
从欧洲和北美的7个国家的52家医院连续纳入2454例符合条件的急性PE患者。主要结局指标是3个月时的全因死亡率。通过多因素分析评估基线因素对生存的预后影响。
2110例（86.0%）患者的PE通过尸检、高概率肺扫描、肺血管造影或静脉超声检查加高度临床怀疑得以证实；ICOPER接受了参与中心提供的未经独立审核的影像诊断和解读；98.0%的患者完成了3个月的随访。3个月时的总体粗死亡率为17.4%（2454例中有426例死亡，包括52例失访患者）：397例死亡中有179例（45.1%）归因于PE，397例中有70例（17.6%）归因于癌症，29例患者的死亡原因信息不详。排除61例尸检时首次发现PE的患者后，3个月时的死亡率为15.3%（2393例中有365例死亡）。在多元回归模型中，年龄超过70岁（风险比1.6[95%CI 1.1 - 2.3]）、癌症（2.3[1.5 - 3.5]）、充血性心力衰竭（2.4[1.5 - 3.7]）、慢性阻塞性肺疾病（1.8[1.2 - 2.7]）、收缩期动脉低血压（2.9[1.7 - 5.0]）、呼吸急促（2.0[1.2 - 3.2]）以及超声心动图显示右心室运动减弱（2.0[1.3 - 2.9]）被确定为显著的预后因素。
PE仍然是一个死亡率很高的重要临床问题。ICOPER的数据提供了发生率，并突出了不良预后类别，这将有助于规划未来针对高危PE患者的试验。
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