Respiratory Department, Hospital Ramón y Cajal and Universidad de Alcalá (IRYCIS), Madrid, Spain.
Respiratory Department, Hospital Ramón y Cajal and Universidad de Alcalá (IRYCIS), Madrid, Spain.
Int J Cardiol. 2020 Mar 1;302:157-163. doi: 10.1016/j.ijcard.2019.11.102. Epub 2019 Nov 14.
The optimal cutoff for systolic blood pressure (SBP) level to define high-risk pulmonary embolism (PE) remains to be defined.
To evaluate the relationship between SBP levels on admission and mortality in patients with acute symptomatic PE, the current study included 39,257 consecutive patients with acute symptomatic PE from the RIETE registry between 2001 and 2018. Primary outcomes included all-cause and PE-specific 30-day mortality. Secondary outcomes included major bleeding and recurrent venous thromboembolism (VTE).
There was a linear inverse relationship between admission SBP and 30-day all-cause and PE-related mortality that persisted after multivariable adjustment. Patients in the lower SBP strata had higher rates of all-cause death (reference: SBP 110-129 mmHg) (adjusted odds ratio [OR] 2.9; 95% confidence interval [CI], 2.0-4.2 for SBP <70 mmHg; and OR 1.7; 95% CI, 1.4-2.1 for SBP 70-89 mmHg). The findings for 30-day PE-related mortality were similar (adjusted OR 4.4; 95% CI, 2.7-7.2 for SBP <70 mmHg; and OR 2.6; 95% CI, 1.9-3.4 for SBP 70-89 mmHg). Patients in the higher strata of SBP had significantly lower rates of 30-day all-cause mortality compared with the same reference group (adjusted OR 0.7; 95% CI, 0.5-0.9 for SBP 170-190 mmHg; and OR 0.6; 95% CI, 0.4-0.9 for SBP >190 mmHg). Consistent findings were also observed for 30-day PE-related death.
In patients with acute symptomatic PE, a low SBP portends an increased risk of all-cause and PE-related mortality. The highest mortality was observed in patients with SBP <70 mmHg.
收缩压（SBP）水平定义高危肺栓塞（PE）的最佳截断值仍有待确定。
为评估急性有症状性 PE 患者入院时 SBP 水平与死亡率之间的关系，本研究纳入了 2001 年至 2018 年 RIETE 注册中心的 39257 例连续急性有症状性 PE 患者。主要结局包括全因和 PE 特异性 30 天死亡率。次要结局包括大出血和复发性静脉血栓栓塞（VTE）。
入院时 SBP 与 30 天全因和 PE 相关死亡率呈线性反比关系，多变量调整后仍持续存在。SBP 较低分层的患者全因死亡率更高（参考：SBP 110-129mmHg）（校正比值比[OR] 2.9；95%置信区间[CI]，SBP <70mmHg 为 2.0-4.2；SBP 70-89mmHg 为 1.7；95%CI，1.4-2.1）。30 天 PE 相关死亡率的结果相似（校正 OR 4.4；95%CI，SBP <70mmHg 为 2.7-7.2；SBP 70-89mmHg 为 2.6；95%CI，1.9-3.4）。与同一参考组相比，SBP 较高分层的患者 30 天全因死亡率显著降低（校正 OR 0.7；95%CI，SBP 170-190mmHg 为 0.5-0.9；SBP >190mmHg 为 0.6；95%CI，0.4-0.9）。PE 相关死亡也观察到了一致的结果。
在急性有症状性 PE 患者中，低 SBP 预示全因和 PE 相关死亡率增加。SBP <70mmHg 的患者死亡率最高。
