P. L. den Exter, MD, Department of Thrombosis and Hemostasis, Leiden University Medical Center, Albinusdreef 2, P.O Box 9600, 2300 RC, Leiden, the Netherlands, Tel: + 31 71 526 2085; Fax: +31 71 524 8140, E-mail:
Thromb Haemost. 2015 Jul;114(1):26-34. doi: 10.1160/TH14-10-0842. Epub 2015 May 28.
The systematic assessment of residual thromboembolic obstruction after treatment for acute pulmonary embolism (PE) has been understudied. This assessment is of potential clinical importance, should clinically suspected recurrent PE occur, or as tool for risk stratification of cardiopulmonary complications or recurrent venous thromboembolism (VTE). This study aimed to assess the rate of PE resolution and its implications for clinical outcome. In this prospective, multi-center cohort study, 157 patients with acute PE diagnosed by CT pulmonary angiography (CTPA) underwent follow-up CTPA-imaging after six months of anticoagulant treatment. Two expert thoracic radiologists independently assessed the presence of residual thromboembolic obstruction. The degree of obstruction at baseline and follow-up was calculated using the Qanadli obstruction index. All patients were followed-up for 2.5 years. At baseline, the median obstruction index was 27.5 %. After six months of treatment, complete PE resolution had occurred in 84.1 % of the patients (95 % confidence interval (CI): 77.4-89.4 %). The median obstruction index of the 25 patients with residual thrombotic obstruction was 5.0 %. During follow-up, 16 (10.2 %) patients experienced recurrent VTE. The presence of residual thromboembolic obstruction was not associated with recurrent VTE (adjusted hazard ratio: 0.92; 95 % CI: 0.2-4.1).This study indicates that the incidence of residual thrombotic obstruction following treatment for PE is considerably lower than currently anticipated. These findings, combined with the absence of a correlation between residual thrombotic obstruction and recurrent VTE, do not support the routine use of follow-up CTPA-imaging in patients treated for acute PE.
急性肺栓塞（PE）治疗后残留血栓栓塞梗阻的系统评估研究较少。如果临床上怀疑复发性 PE 发生，或者作为心肺并发症或复发性静脉血栓栓塞（VTE）风险分层的工具，这种评估具有潜在的临床重要性。本研究旨在评估 PE 缓解率及其对临床结果的影响。在这项前瞻性、多中心队列研究中，157 例经 CT 肺动脉造影（CTPA）诊断为急性 PE 的患者在抗凝治疗 6 个月后接受了随访 CTPA 成像。两位专家胸部放射科医生独立评估了残留血栓栓塞梗阻的存在情况。使用 Qanadli 梗阻指数评估基线和随访时的梗阻程度。所有患者均随访 2.5 年。基线时，梗阻指数中位数为 27.5%。治疗 6 个月后，84.1%（95%置信区间：77.4-89.4%）的患者完全缓解 PE。25 例存在残留血栓性梗阻的患者的梗阻指数中位数为 5.0%。随访期间，16 例（10.2%）患者发生复发性 VTE。残留血栓栓塞梗阻的存在与复发性 VTE 无关（调整后的危险比：0.92；95%置信区间：0.2-4.1）。本研究表明，PE 治疗后残留血栓性梗阻的发生率远低于目前的预期。这些发现，加上残留血栓性梗阻与复发性 VTE 之间没有相关性，不支持对接受急性 PE 治疗的患者常规进行随访 CTPA 成像。
