Section of Vascular Medicine, Department of General Internal Medicine-Endocrinology, LUMC, Leiden, The Netherlands.
Am J Respir Crit Care Med. 2010 Mar 1;181(5):501-6. doi: 10.1164/rccm.200907-1141OC. Epub 2009 Dec 3.
There is a lack of information on the long-term prognosis of patients with acute pulmonary embolism (PE).
To assess the long-term risk for adverse events after PE.
Consecutive patients diagnosed with PE between January 2001 and July 2007, and patients in whom PE was ruled out from a previous study were followed until July 2008 for the occurrence of adverse clinical events: mortality, symptomatic recurrent venous thromboembolism, cancer, arterial cardiovascular events and chronic thromboembolic pulmonary hypertension. Hazard ratios (HR) for all endpoints and a combined endpoint were calculated and adjusted for potential confounders.
Three hundred eight patients with unprovoked, 558 with provoked, and 334 without PE were studied with a median follow-up period of 3.3 years. Patients with unprovoked PE had a lower overall risk for mortality than patients with provoked PE (HR, 0.59; 95% confidence interval [CI], 0.43-0.82), but a higher risk for nonmalignancy-related mortality (HR, 1.8; 95% CI, 1.3-2.5), recurrent venous thromboembolism (HR, 2.1; 95% CI, 1.3-3.1), cancer (HR, 4.4; 95% CI, 2.0-10), cardiovascular events (HR, 2.6; 95% CI, 1.5-3.8) and chronic thromboembolic pulmonary hypertension (1.5 vs. 0%). The risk for the combined endpoint did not differ between both groups (HR, 0.98; 95% CI, 0.82-1.1). Patients without PE had similar risks for malignancy and cardiovascular events than patients with provoked PE, but lower risks for the remaining outcomes. The fraction of both patients with provoked and unprovoked PE without events after 1 year was only 70% and decreased to fewer than 60% after 2 years and fewer than 50% after 4 years, whereas this latter was 84% for the control patients.
The clinical course of acute PE is complicated by high rates of serious adverse events, which occur in half of the patients within 4 years.
急性肺栓塞（PE）患者的长期预后信息有限。
评估 PE 后不良事件的长期风险。
连续纳入 2001 年 1 月至 2007 年 7 月诊断为 PE 的患者，以及之前研究中排除 PE 的患者，随访至 2008 年 7 月，以发生不良临床事件：死亡、有症状的复发性静脉血栓栓塞症、癌症、动脉心血管事件和慢性血栓栓塞性肺动脉高压。计算所有终点和复合终点的危险比（HR），并对潜在混杂因素进行调整。
308 例特发性、558 例诱发性和 334 例非 PE 患者纳入研究，中位随访时间为 3.3 年。特发性 PE 患者的总体死亡率低于诱发性 PE 患者（HR，0.59；95%置信区间[CI]，0.43-0.82），但非恶性相关死亡率（HR，1.8；95% CI，1.3-2.5）、复发性静脉血栓栓塞症（HR，2.1；95% CI，1.3-3.1）、癌症（HR，4.4；95% CI，2.0-10）、心血管事件（HR，2.6；95% CI，1.5-3.8）和慢性血栓栓塞性肺动脉高压（1.5 比 0%）的风险更高。两组间复合终点的风险无差异（HR，0.98；95% CI，0.82-1.1）。无 PE 患者的恶性和心血管事件风险与诱发性 PE 患者相似，但其他结局风险较低。1 年后有症状的复发性静脉血栓栓塞症和无事件的患者比例仅为 70%，2 年后降至 60%以下，4 年后降至 50%以下，而对照组为 84%。
急性 PE 的临床病程复杂，严重不良事件发生率高，4 年内有一半患者发生不良事件。
