Heart and Lung Center, Helsinki University and Helsinki University Hospital, Stenbäckinkatu 9, Lumivaarantie 23A, 02140, Espoo, Helsinki, Finland.
J Thromb Thrombolysis. 2022 Feb;53(2):550-556. doi: 10.1007/s11239-021-02550-z. Epub 2021 Aug 16.
Pulmonary embolism (PE) mortality has decreased in the last decades but acute PE is still associated with significant fatality. Specific information on fatal PE patients could guide how to efficiently improve PE management but to date this information has been scarce. All the individuals with PE defined as an immediate or underlying cause of death were collected from the death certificate archive of the Hospital District of Helsinki and Uusimaa, Finland, including approximately 1.7 million inhabitants (2015-2018). Crude and age-adjusted mortality rates and proportional mortality were calculated, and the distribution of comorbidities at death and death location (in-hospital, palliative care, or out-of-hospital) was analyzed. In total, 451 individuals with fatal PE were identified (238 females) with a mean age of 72 years (SD 13.5 year). Most of the fatal PEs (n = 264, 54.5%) occurred out-of-hospital and surprisingly, 70 (26.5%) of these individuals s had a history of mental illness or substance abuse. The out-of-hospital resuscitation was attempted in 108 (40.1%) individuals but only 7 (6.5%) received thrombolysis during resuscitation. Fatal PE occurred during hospitalization in 98 individuals and in 54 (55.1%), the diagnosis was only made postmortem. Majority of the fatal PEs occurred out-of-hospital and were diagnosed postmortem whereas only small proportion of deaths occurred to in-hospital PE patients. The earlier diagnosis of PE, which may be accomplished by raising the general awareness of PE, is necessary to prevent these sudden deaths of whom many occurred to individuals with history of mental illnesses or substance abuse.
肺栓塞（PE）的死亡率在过去几十年中有所下降，但急性 PE 仍然与显著的死亡率相关。关于致命性 PE 患者的具体信息可以指导如何有效地改善 PE 管理，但迄今为止，这方面的信息还很匮乏。所有在芬兰赫尔辛基和乌西玛地区医院区的死亡证明档案中被定义为直接或潜在死因的 PE 患者都被收集到了，包括大约 170 万居民（2015-2018 年）。计算了粗死亡率和年龄调整死亡率以及比例死亡率，并分析了死亡时合并症的分布和死亡地点（院内、姑息治疗或院外）。总共确定了 451 例致命性 PE 患者（238 例女性），平均年龄为 72 岁（标准差 13.5 岁）。大多数致命性 PE（n=264，54.5%）发生在院外，令人惊讶的是，其中 70 例（26.5%）患者有精神病史或滥用药物史。108 例（40.1%）患者尝试了院外复苏，但只有 7 例（6.5%）在复苏期间接受了溶栓治疗。98 例致命性 PE 发生在住院期间，54 例（55.1%）仅在死后才被诊断。大多数致命性 PE 发生在院外，且死后才被诊断，而只有少数死亡发生在院内 PE 患者。需要提高对 PE 的普遍认识，以便更早地诊断 PE，从而预防这些突然死亡，其中许多死亡发生在有精神病史或滥用药物史的患者身上。
