Respiratory Department, Ramón y Cajal Hospital and Universidad de Alcalá IRYCIS, Madrid, Spain.
Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York-Presbyterian Hospital, New York, USA.; Center for Outcomes Research and Evaluation (CORE), Yale University School of Medicine, New Haven, USA.
Thromb Res. 2018 Apr;164:40-44. doi: 10.1016/j.thromres.2018.02.140. Epub 2018 Feb 17.
In patients with acute pulmonary embolism (PE), studies have shown an association between coexisting deep vein thrombosis (DVT) and short-term prognosis. It is not known whether complete compression ultrasound testing (CCUS) improves the risk stratification of their disease beyond the recommended prognostic models.
We included patients with normotensive acute symptomatic PE and prognosticated them with the European Society of Cardiology (ESC) risk model for PE. Subsequently, we determined the prognostic significance of coexisting DVT in patients with various ESC risk categories. The primary endpoint was a complicated course after the diagnosis of PE, defined as death from any cause, haemodynamic collapse, or adjudicated recurrent PE.
According to the ESC model, 37% of patients were low-risk, 56% were intermediate-low risk, and 6.7% were intermediate-high risk. CCUS demonstrated coexisting DVT in 375 (44%) patients. Among the 313 patients with low-risk PE, coexisting DVT (46%) did not show a significant increased risk of complicated course (2.8%; 95% confidence interval [CI], 0.8%-7.0%), compared with those without DVT (0.6%; 95% CI, 0%-3.2%), (P = 0.18). Of the 478 patients with intermediate-low risk PE, a complicated course was 14% and 6.8% for those with and without DVT, respectively (P = 0.01). Of the 57 patients that had intermediate-high risk PE, a complicated course occurred in 17% and 18% for those with and without DVT, respectively (P = 1.0).
In normotensive patients with PE, testing for coexisting DVT might improve risk stratification of patients at intermediate-low risk for short-term complications.
在急性肺栓塞（PE）患者中，已有研究表明同时存在深静脉血栓形成（DVT）与短期预后相关。目前尚不清楚完全压缩超声检查（CCUS）是否能在推荐的预后模型之外改善疾病的风险分层。
我们纳入了血压正常的急性有症状 PE 患者，并采用欧洲心脏病学会（ESC）的 PE 风险模型对其进行预后评估。随后，我们确定了在不同 ESC 风险类别的患者中同时存在 DVT 的预后意义。主要终点是 PE 诊断后的复杂病程，定义为任何原因导致的死亡、血流动力学崩溃或判定的复发性 PE。
根据 ESC 模型，37%的患者为低危，56%为中低危，6.7%为中高危。CCUS在 375 例（44%）患者中显示同时存在 DVT。在 313 例低危 PE 患者中，同时存在 DVT（46%）并未显著增加复杂病程的风险（2.8%；95%置信区间[CI]，0.8%-7.0%），与无 DVT 患者相比（0.6%；95% CI，0%-3.2%）（P=0.18）。在 478 例中低危 PE 患者中，有 DVT 的患者复杂病程发生率为 14%，无 DVT 的患者为 6.8%（P=0.01）。在 57 例中高危 PE 患者中，有 DVT 的患者复杂病程发生率为 17%，无 DVT 的患者为 18%（P=1.0）。
在血压正常的 PE 患者中，检测同时存在的 DVT 可能会改善中低危患者短期并发症的风险分层。
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