Cardi Silvia, Barco Stefano, Wolf Simon, Demelo-Rodríguez Pablo, Pérez-Pinar Montserrat, Skride Andris, Tazi-Mezalek Zoubida, López-Sáez Juan Bosco, Marchena Pablo Javier, Monreal Manuel
Italy Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy.
IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
Clin Res Cardiol. 2025 Jun 30. doi: 10.1007/s00392-025-02706-4.
The role of atherosclerosis in pulmonary embolism (PE) prognosis remains uncertain. Our study assesses characteristics and outcomes of acute PE patients according to the presence and extent of atherosclerotic disease.
Using data from the RIETE registry, acute PE patients were classified into three groups based on personal history: (1) polyvascular atherosclerosis, (2) single vascular atherosclerosis, and (3) no symptomatic atherosclerosis. Primary outcomes included recurrent PE and venous thromboembolism (VTE), arterial events, major bleeding, and all-cause death. Hazard ratios (HR) and Kaplan-Meier curves for clinical outcomes were estimated using Cox regression models.
Among 47,578 acute PE patients, 1,040 had polyvascular, 6,191 single-vascular, and 40,347 no atherosclerosis. During a median follow-up of 331 days, Adverse outcomes were more frequent in patients with atherosclerosis (vs. no atherosclerosis), rising with the number of affected vascular territories. Recurrent PE rates were 2.8, 1.6, and 1.2 per 100 patient-years in the polyvascular, single-vascular, and no atherosclerosis groups. Multivariable analysis showed a dose-dependent relationship between atherosclerosis and recurrent PE risk, with HRs of 3.2 (95% CI 1.7-5.9) and 1.6 (95% CI 1.1-2.3) for polyvascular and single-vascular disease (vs. no atherosclerosis). The risk of all-cause death followed a similar trend, with HRs of 1.3 (95% CI 1.1-1.6) and 1.2 (95% CI 1.1-1.4), respectively. Major bleeding appeared to be influenced by overall health status and antithrombotic therapy intensity.
Atherosclerosis in acute PE patients may serve as a marker of disease severity and lead independently to adverse outcomes, highlighting the importance of cardiovascular risk stratification.
动脉粥样硬化在肺栓塞（PE）预后中的作用仍不确定。我们的研究根据动脉粥样硬化疾病的存在情况和范围评估急性PE患者的特征及预后。
利用RIETE注册研究的数据，根据个人病史将急性PE患者分为三组：（1）多血管动脉粥样硬化，（2）单血管动脉粥样硬化，（3）无症状动脉粥样硬化。主要结局包括复发性PE和静脉血栓栓塞（VTE）、动脉事件、大出血和全因死亡。使用Cox回归模型估计临床结局的风险比（HR）和Kaplan-Meier曲线。
在47578例急性PE患者中，1040例有多血管病变，6191例有单血管病变，40347例无动脉粥样硬化。在中位随访331天期间，动脉粥样硬化患者（与无动脉粥样硬化患者相比）的不良结局更常见，且随着受影响血管区域数量的增加而上升。多血管、单血管和无动脉粥样硬化组的复发性PE发生率分别为每100患者年2.8、1.6和1.2例。多变量分析显示动脉粥样硬化与复发性PE风险之间存在剂量依赖关系，多血管和单血管疾病（与无动脉粥样硬化相比）的HR分别为3.2（95%CI 1.7-5.9）和1.6（95%CI 1.1-2.3）。全因死亡风险呈现类似趋势，HR分别为1.3（95%CI 1.1-1.6）和1.2（95%CI 1.1-1.4）。大出血似乎受总体健康状况和抗栓治疗强度的影响。
急性PE患者的动脉粥样硬化可能是疾病严重程度的标志物，并独立导致不良结局，凸显了心血管风险分层的重要性。
