Abstract 13452: Sex Differences in Presentation, Management, and Outcomes Among Patients Hospitalized With Acute Pulmonary Embolism

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Abby M Pribish ◽  
Sebastian Beyer ◽  
Anna K Krawisz ◽  
Ido Weinberg ◽  
Brett J Carroll ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Tertiary Care ◽  
Gender Disparities ◽  
Short Term ◽  
Survival Difference ◽  
Advanced Therapies ◽  
Comorbidity Burden ◽  
Gender Based ◽  
The Impact

Introduction: The presence of gender disparities in cardiovascular disease has been well-described, but there is a paucity of data regarding the impact of gender on the presentation, management and outcomes of acute pulmonary embolism (PE). Hypothesis: We hypothesized that there are no gender-based differences in PE management or outcomes. Methods: We identified all patients admitted to our institution with acute PE from 8/1/2012-7/1/2018. We stratified presenting characteristics, management and outcomes between women and men. Outcomes included major bleeding, survival, 90-day readmission, and 90-day recurrent venous thromboembolism (VTE). Inverse probability of treatment weighting was used to evaluate the independent association between sex and in-hospital and short-term outcomes. Results: The study included 2031 patients with PE, 53.2% of whom were women. Women had a higher mean age (63.8 years vs 62.3 years, P=0.04). PE severity was similar between women and men (massive: 4.9% vs 3.6%; submassive: 43.9% vs 41.8%; P=0.19), but women were more likely to present with dyspnea (59.8% vs 52.0%, P<0.001) and had higher median NT-pro-BNP levels (605 pg/mL [IQR 143-2582] vs 319 pg/mL [IQR 82-1576], P<0.001). Although the comorbidity burden was similar, women were less likely to have a history of PE (19.3% vs 24.2%, P=0.01), smoking (43.1% vs 53.3%, P<0.001), or myocardial infarction (6.6% vs 9.7%, P=0.01). In unadjusted analyses, women were less likely to survive to discharge (92.4% vs 94.7%, P=0.04), but after adjustment, there was no gender-based survival difference. There were also no gender differences in PE-related diagnostic studies, use of advanced therapies, or other short-term outcomes, before and after adjustment (p>0.05 for all) (Fig 1). Conclusions: In this large PE cohort from a tertiary care institution, women had different comorbidity profiles and PE presentations than men. Despite this, there were no gender disparities in PE management or outcomes.

scholarly journals Sex differences in presentation, management, and outcomes among patients hospitalized with acute pulmonary embolism

2020 ◽  
Vol 25 (6) ◽  
pp. 541-548
Author(s):  
Abby M Pribish ◽  
Sebastian E Beyer ◽  
Anna K Krawisz ◽  
Ido Weinberg ◽  
Brett J Carroll ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Sex Differences ◽  
Acute Pulmonary Embolism ◽  
Tertiary Care ◽  
Smoking History ◽  
Care Hospital ◽  
Survival Difference ◽  
Advanced Therapies ◽  
The Impact ◽  
Acute Pe

While the presence of gender disparities in cardiovascular disease have been described, there is a paucity of data regarding the impact of sex in acute pulmonary embolism (PE). We identified all patients admitted to a tertiary care hospital with acute PE between August 1, 2012 through July 1, 2018. We stratified the presenting characteristics, management, and outcomes between women and men. Of the 2031 patients admitted with acute PE, 1081 (53.2%) were women. Women were more likely to present with dyspnea (59.8% vs 52.0%, p < 0.001) and less likely to present with hemoptysis (1.9% vs 4.0%, p = 0.01). Women were older (63.8 ± 17.4 years vs 62.3 ± 15.0 years, p = 0.04), but had lower rates of myocardial infarction, liver disease, smoking history, and prior DVT. PE severity was similar between women and men (massive: 4.9% vs 3.6%; submassive: 43.9% vs 41.8%; p = 0.19), yet women were more likely to present with normal right ventricular size on a surface echocardiogram (63.2% vs 54.8%, p = 0.01). In unadjusted analyses, women were less likely to survive to discharge (92.4% vs 94.7%, p = 0.04), but after adjustment, there was no sex-based survival difference. There were no sex differences in the PE-related diagnostic studies performed, use of advanced therapies, or short-term outcomes, before and after adjustment ( p > 0.05 for all). In this large PE cohort from a tertiary care institution, women had different comorbidity profiles and PE presentations compared with men. Despite these differences, there were no sex disparities in PE management or outcomes.

scholarly journals Symptom Duration Is Positively Correlated with Factor XIIIa Activity in Acute Pulmonary Embolism

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5047-5047
Author(s):  
Yevgeniy Brailovsky ◽  
Debra Hoppensteadt ◽  
Omer Iqbal ◽  
Kevin Simpson ◽  
Nathan Mcclane ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Conflicts Of Interest ◽  
Critical Role ◽  
Tertiary Care ◽  
Response To Therapy ◽  
Factor Xiiia ◽  
Symptom Duration ◽  
The Impact ◽  
D Dimer

Abstract Background Acute pulmonary embolism (PE) patients are at variable risk of morbidity, mortality, and response to therapy. Patients often present at various time points from the symptom onset. Several factors may shed light into the state of endogenous thrombotic and fibrinolytic system at the time of presentation. Factor XIIIa plays a critical role in clot stabilization and may impact clot dissolution. Relation of Factor XIIIa activity and symptom duration is not known. Methods We prospectively collected blood samples from patients evaluated by Pulmonary Embolism Response Team at a tertiary care center. Blood was centrifuged, and plasma collected for analysis. We used ELISA method utilizing a commercially available kit from Hyphen, BioMed (Neuville-sur-Oise France), specific for measurement of Factor XIIIa, D-dimer, and Pro-TAFI antigens. Baseline clinical characteristics were collected from electronic medical record. Symptom duration was gathered from patient subjective assessment. Additional workup included radiographic and echocardiographic evaluation. We performed correlation analysis to test the association between symptom duration and Factor XIIIa activity, D-dimer, and Pro-TAFI antigen. Additionally we performed linear regression analyses to quantify the degree of association of symptom duration and Factor XIIIa activity. Results ±±9.8, 8 patients were treated with catheter directed thrombolysis, while the rest were treated with anticoagulation alone. Symptom duration was positively correlated with Factor XIIIa activity (r2=0.227). More so, for every one day increase in symptom duration the Factor XIIIa activity was increased by 2.2%. (p=0.014). We demonstrated no correlation between symptom duration and D-Dimer (p=0.58) or symptom duration and Pro-TAFI antigen (p=0.84). Conclusion In patients with acute PE, symptom duration positively correlated with Factor XIIIa activity, for every one day increase in symptom duration the Factor XIIIa activity was increased by 2.2%. Future studies are needed to ascertain the impact of Factor XIIIa activity and clot dissolution as well as functional outcomes. Figure. Figure. Disclosures No relevant conflicts of interest to declare.

scholarly journals Computed Tomography Pulmonary Perfusion for Prediction of Short-Term Clinical Outcome in Acute Pulmonary Embolism

TH Open ◽  
2021 ◽  
Vol 05 (01) ◽  
pp. e66-e72
Author(s):  
Lisette F. van Dam ◽  
Lucia J. M. Kroft ◽  
Menno V. Huisman ◽  
Maarten K. Ninaber ◽  
Frederikus A. Klok
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Predictive Value ◽  
Acute Pulmonary Embolism ◽  
Clinical Presentation ◽  
Reperfusion Therapy ◽  
Pulmonary Perfusion ◽  
Short Term ◽  
Acute Pe ◽  
Related Mortality

Abstract Background Computed tomography pulmonary angiography (CTPA) is the imaging modality of choice for the diagnosis of acute pulmonary embolism (PE). With computed tomography pulmonary perfusion (CTPP) additional information on lung perfusion can be assessed, but its value in PE risk stratification is unknown. We aimed to evaluate the correlation between CTPP-assessed perfusion defect score (PDS) and clinical presentation and its predictive value for adverse short-term outcome of acute PE. Patients and Methods This was an exploratory, observational study in 100 hemodynamically stable patients with CTPA-confirmed acute PE in whom CTPP was performed as part of routine clinical practice. We calculated the difference between the mean PDS in patients with versus without chest pain, dyspnea, and hemoptysis and 7-day adverse outcome. Multivariable logistic regression analysis and likelihood-ratio test were used to assess the added predictive value of PDS to CTPA parameters of right ventricle dysfunction and total thrombus load, for intensive care unit admission, reperfusion therapy and PE-related death. Results We found no correlation between PDS and clinical symptoms. PDS was correlated to reperfusion therapy (n = 4 with 16% higher PDS, 95% confidence interval [CI]: 3.5–28%) and PE-related mortality (n = 2 with 22% higher PDS, 95% CI: 4.9–38). Moreover, PDS had an added predictive value to CTPA assessment for PE-related mortality (from Chi-square 14 to 19, p = 0.02). Conclusion CTPP-assessed PDS was not correlated to clinical presentation of acute PE. However, PDS was correlated to reperfusion therapy and PE-related mortality and had an added predictive value to CTPA-reading for PE-related mortality; this added value needs to be demonstrated in larger studies.

Rapid improvement of renal function in patients with acute pulmonary embolism indicates favorable short term prognosis

2012 ◽  
Vol 130 (3) ◽  
pp. e37-e42 ◽  
Author(s):  
Maciej Kostrubiec ◽  
Andrzej Łabyk ◽  
Justyna Pedowska-Włoszek ◽  
Szymon Pacho ◽  
Olga Dzikowska-Diduch ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Renal Function ◽  
Acute Pulmonary Embolism ◽  
Short Term ◽  
Rapid Improvement

scholarly journals Pleural effusion as an indicator of short term mortality in acute pulmonary embolism

2018 ◽  
Vol 66 (3) ◽  
pp. 185-196
Author(s):  
Şehnaz Olgun Yıldızeli ◽  
Umut Sabri Kasapoğlu ◽  
Hüseyin Arıkan ◽  
Canan Çimşit ◽  
Nuri Çagatay Çimşit ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pleural Effusion ◽  
Acute Pulmonary Embolism ◽  
Short Term ◽  
Short Term Mortality

Electrocardiographic Score and Short-Term Outcomes of Acute Pulmonary Embolism

2007 ◽  
Vol 100 (7) ◽  
pp. 1172-1176 ◽  
Author(s):  
Mehrdad Seilanian Toosi ◽  
John D. Merlino ◽  
Kenneth V. Leeper
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Short Term

Impact of syncope and pre-syncope on short-term mortality in patients with acute pulmonary embolism

2018 ◽  
Vol 54 ◽  
pp. 27-33 ◽  
Author(s):  
Loris Roncon ◽  
Marco Zuin ◽  
Franco Casazza ◽  
Cecilia Becattini ◽  
Claudio Bilato ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Short Term ◽  
Short Term Mortality

Abstract 14499: Impact of Pre-existing and New Incident Atrial Fibrillation on Outcomes of Patients With Acute Pulmonary Embolism: Findings From an International Registry

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Behnood Bikdeli ◽  
David Jimenez ◽  
Jorg Del Toro ◽  
Gregory Piazza ◽  
Augussina Rivas ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Embolism ◽  
Ischemic Stroke ◽  
Acute Pulmonary Embolism ◽  
Adverse Outcomes ◽  
Risk Of Mortality ◽  
Patient Groups ◽  
The Impact ◽  
Related Mortality

Background: Atrial fibrillation (AF) may occur prior to or early in the course of acute pulmonary embolism (PE). The impact of AF on outcomes of patients with PE remains uncertain. Methods: Using the data from a large prospective multicenter registry of patients with objectively-confirmed PE (04/2014 to 01/2020), we identified three patient groups: 1) those with pre-existing AF 2) patients with newly identified AF within 2 days from the index PE (incident AF) and 3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, in unadjusted and multivariable adjusted models considering those without AF as referent. Results: Among 16,497 patients with PE, 792 had pre-existing AF. Compared with those without AF, patients with pre-existing AF, had increased odds of 90-day all-cause (Odds ratio [OR]: 2.81 (95% confidence interval [CI]: 2.33-3.38) and PE-related mortality (OR: 2.38, 95% CI: 1.37-4.14). After multivariable adjustment, pre-existing AF significantly increased the odds of all-cause mortality (OR: 1.91, 95% CI: 1.57-2.32) but not PE-related mortality (OR: 1.50; 95% CI: 0.85-2.66). Pre-existing AF was associated with increased hazard for ischemic stroke at 1-year follow-up (hazard ratio [HR]: 5.48; 95% CI: 3.10-9.69). Among 16,497 patients with PE, 445 developed incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR: 2.28; 95% CI: 1.75-2.97) and PE-related (OR: 3.64; 95% CI: 2.01-6.59) mortality. Findings were similar in multivariable analyses and at 1-year follow-up (Figure). No patients with incident AF developed ischemic stroke. Conclusion: In patients with acute symptomatic PE, both pre-existing AF and incident AF predict an adverse clinical course, although the type of adverse outcomes may be different depending on the timing of AF onset.

scholarly journals Impact of persistent anaemia on mortality in patients hospitalised with acute pulmonary embolism: an Australian retrospective observational study

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e027112
Author(s):  
Wallace Chow ◽  
Christopher Wong ◽  
Jerrett K Lau ◽  
Vincent Chow ◽  
Leonard Kritharides ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Observational Study ◽  
Acute Pulmonary Embolism ◽  
Retrospective Observational Study ◽  
Study Cohort ◽  
Prognostic Impact ◽  
Tertiary Referral Centre ◽  
Baseline Haemoglobin ◽  
The Impact ◽  
Acute Pe

ObjectivesAnaemia is associated with increased mortality in acute pulmonary embolism (PE) patients. However, prior studies have not examined the prognostic impact of trends in plasma haemoglobin during admission. This study investigates the impact of changes in haemoglobin level on mortality during hospital stay in acute PE.Study designA retrospective observational study.SettingTertiary-referral centre in Australia.ParticipantsConsecutive patients from 2000 to 2012 admitted with confirmed acute PE were identified from a dedicated PE database. Haemoglobin levels on days 1, 3–4, 5–6 and 7 of admission were retrieved. Patients without both baseline haemoglobin and subsequent haemoglobin levels were excluded (n=327), leaving 1099 patients as the study cohort. Anaemia was defined as haemoglobin <130 g/L for men and <120 g/L for women. There were 576 patients without anaemia throughout admission, 65 with transient anaemia (anaemic on day 1, but subsequently normalised during admission), 122 with acquired anaemia (normal on day 1 but developed anaemia during admission) and 336 with persistent anaemia. A total of 71 patients received blood transfusion during admission.Main outcome measure6-month mortality was tracked from a state-wide death database and analysed using multivariable modelling.ResultsAfter adjusting for transfusion, patietns with persistent anaemia had a significantly increased 6-month mortality risk (adjusted HR 1.97, 95% CI 1.26 to 3.09, p=0.003) compared with patients without anaemia. There was no difference in mortality between patients with transient or acquired anaemia and patients without anaemia.ConclusionAmong patients who had anaemia during their admission for acute PE, only the subgroup with persistent anaemia demonstrated worse outcomes.

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