Catheter-Directed Therapies in Patients with Pulmonary Embolism: Predictive Factors of In-Hospital Mortality and Long-Term Follow-Up

(1) Background: Catheter-directed therapies (CDT) may be considered for selected patients with pulmonary embolism (PE); (2) Methods: Retrospective observational study including all consecutive patients with acute PE undergoing CDT (mechanical or pharmacomechanical) from January 2010 through December 2020. The aim was to evaluate in-hospital and long-term mortality and its predictive factors; (3) Results: We included 63 patients, 43 (68.3%) with high-risk PE. All patients underwent mechanical CDT and, additionally, 27 (43%) underwent catheter-directed thrombolysis. Twelve (19%) patients received failed systemic thrombolysis (ST) prior to CDT, and an inferior vena cava (IVC) filter was inserted in 28 (44.5%) patients. In-hospital PE-related and all-cause mortality rates were 31.7%; 95% CI 20.6–44.7% and 42.9%; 95% CI 30.5–56%, respectively. In multivariate analysis, age > 70 years and previous ST were strongly associated with PE-related and all-cause mortality, while IVC filter insertion during the CDT was associated with lower mortality rates. After a median follow-up of 40 (12–60) months, 11 more patients died (mortality rate of 60.3%; 95% CI 47.2–72.4%). Long-term survival was significantly higher in patients who received an IVC filter; (4) Conclusions: Age > 70 years and failure of previous ST were associated with mortality in acute PE patients treated with CDT. In-hospital and long-term mortality were lower in patients who received IVC filter insertion.

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Long-term mortality after massive, submassive, and low-risk pulmonary embolism

Vascular Medicine ◽

10.1177/1358863x19886374 ◽

2019 ◽

Vol 25 (2) ◽

pp. 141-149 ◽

Cited By ~ 5

Author(s):

Rajesh Gupta ◽

Zaid Ammari ◽

Osama Dasa ◽

Mohammed Ruzieh ◽

Jordan J Burlen ◽

...

Keyword(s):

Pulmonary Embolism ◽

Mortality Rate ◽

Tertiary Care ◽

Low Risk ◽

All Cause Mortality ◽

Acute Pe ◽

Long Term Mortality ◽

Overall Mortality

Guidelines for management of normotensive patients with acute pulmonary embolism (PE) emphasize further risk stratification on the basis of right ventricular (RV) size and biomarkers of RV injury or strain; however, the prognostic importance of these factors on long-term mortality is not known. We performed a retrospective cohort study of subjects diagnosed with acute PE from 2010 to 2015 at a tertiary care academic medical center. The severity of initial PE presentation was categorized into three groups: massive, submassive, and low-risk PE. The primary endpoint of all-cause mortality was ascertained using the Centers for Disease Control National Death Index (CDC NDI). A total of 183 subjects were studied and their median follow-up was 4.1 years. The median age was 65 years. The 30-day mortality rate was 7.7% and the overall mortality rate through the end of follow-up was 40.4%. The overall mortality rates for massive, submassive, and low-risk PE were 71.4%, 44.5%, and 28.1%, respectively ( p < 0.001). Landmark analysis using a 30-day cutpoint demonstrated that subjects presenting with submassive PE compared with low-risk PE had increased mortality during both the short- and the long-term periods. The most frequent causes of death were malignancy, cardiac disease, respiratory disease, and PE. Independent predictors of all-cause mortality were cancer at baseline, age, white blood cell count, diabetes mellitus, liver disease, female sex, and initial presentation with massive PE. In conclusion, the diagnosis of acute PE was associated with substantial long-term mortality. The severity of initial PE presentation was associated with both short- and long-term mortality.

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Long-term mortality predictors in pulmonary embolism

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.197 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

R Caldeira Da Rocha ◽

R Fernandes ◽

M Carrington ◽

F Claudio ◽

J Pais ◽

...

Keyword(s):

Pulmonary Embolism ◽

Troponin I ◽

Cox Regression ◽

Imaging Features ◽

All Cause Mortality ◽

History Of ◽

Acute Pe ◽

Long Term Mortality

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Acute Pulmonary embolism(PE)is a common and potentially fatal medical condition.In contemporary adult population,PE is associated with increased long-term mortality. Purpose Identify predictors of long-term all-cause mortality in patients(pts)admitted due to pulmonary embolism. Methods Retrospective single-center study of hospitalized pts with acute PE between 2015 and 2018.We evaluated comorbidities, admission(AD)presentation such as vitals(with hypotension defined as systolic blood pressure(SBP)<90mmHg,and tachycardia as >100ppm),lab analyses during in-hospital period,imaging features. Mortality(long-term >3months)was also assessed using national registry of citizens.We performed uni and multivariate analysis to compare clinical characteristics of pts who died and who survived,using Cox regression and Kaplan-Meier methods.For the predictor age we assessed discrimination power and defined the best cut-off using area under the ROC curve(AUC)method. Results From 2015 to 2018,182 pts were admitted with diagnosis of pulmonary embolism,60% female with a mean age of 74 ± 13years old.Seventy-one(39%)pts died after a median follow-up of 26[10-41]months.Pts who died were older(80 ± 8 vs71 ± 14,p < 0.001).The best cut-off value of age to predict mortality with 70%sensitivity and 61%specificity was 77years old(AUC 0.703;CI95% 0.63-0.78).Pts who died had more frequently history of neoplasia (21%vs 9%,p = 0.009).The remaining comorbidities were similar in both groups.Pts who did not survive were more frequently hypotensive(28% vs 13%, p = 0.008),had higher creatinine(1.1[0.8-1.4] vs 1.0[0.8-1.2], p = 0.002), lactate(2.3[1.8-2.8]vs 1.8[1.5-2.0],p = 0.007)and NT-proBNP(4694[1498-12300]vs2070[492-6660], p < 0.001)at AD.Maximum troponin I (0.176[0.037-0.727]vs0.126[0.050-0.365]ng/mL,p = 0.012) was also higher than in pts who survived. After adjusting for history of neoplasia,ADcreatinine and maximum troponin I,we found that age (HR1.057;95%CI 1.01-1.11,p = 0.021),AD SBP < 90(HR 2.215;95%CI 1.03-4.76,p = 0.041),lactate(HR 1.17;95%CI 1.01-1.36,p = 0.035)and NT-proBNP(HR 1.510;95%CI 1.250-1.780,p < 0.001)were independent predictors of all-cause mortality. Conclusion In our cohort,the long-term all-cause mortality was 39%over a median follow-up of 26[10-41]months.In patients with pulmonary embolism,aside from already identified age(especially when ≥70 years old)and NT-proBNP,lactate should also be considered when evaluating long-term prognosis. Furthermore,hypotension at admission increases by 2fold long-term mortality in patients who suffered acute PE.

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Glomerular Filtration Rate as a Prognostic Factor for Long-Term Mortality after Acute Pulmonary Embolism

Medical Principles and Practice ◽

10.1159/000497436 ◽

2019 ◽

Vol 28 (3) ◽

pp. 264-272 ◽

Cited By ~ 2

Author(s):

Valdis Ģībietis ◽

Dana Kigitoviča ◽

Barbara Vītola ◽

Sintija Strautmane ◽

Andris Skride

Keyword(s):

Pulmonary Embolism ◽

Glomerular Filtration Rate ◽

Filtration Rate ◽

Acute Pulmonary Embolism ◽

All Cause Mortality ◽

Acute Pe ◽

D Dimer ◽

Active Cancer ◽

Long Term Mortality

Background: In-hospital mortality for patients presenting with acute pulmonary embolism (PE) has been reported to be up to 7 times higher for patients with decreased estimated glomerular filtration rate (eGFR). However, few studies have assessed its effect on long-term mortality. Objective: To determine the impact of eGFR and creatinine clearance (CrCl) on long-term all-cause mortality following acute PE in association with other routine laboratory analyses and comorbidities. Patients/Methods: The prospective study enrolled 141 consecutive patients presenting with objectively confirmed acute PE. Demographic, clinical data, comorbidities, and laboratory values were recorded. CrCl and GFR were estimated using the Cockcroft-Gault, MDRD, and chronic kidney disease (CKD)-EPI equations. Patients were followed up at 90 days and 1 year after the event. Results: In univariate analyses, age, active cancer, PE severity index (PESI), CrCl and eGFR, D-dimer value, and high-density lipoprotein level were found to be significantly associated with mortality in 90 days and 1 year. Additionally, body mass index was significant in the 1-year follow-up. CrCl by Cockcroft-Gault (90-day: area under the curve [AUC] 0.763; 1-year: AUC 0.718) demonstrated higher discriminatory power for predicting mortality than eGFR by the MDRD (AUC 0.686; AUC 0.609) and CKD-EPI (AUC 0.697; AUC 0.630) equations. In multivariate analyses, active cancer, CrCl by Cockcroft-Gault (90-day: hazard ratio [HR] 0.948, 95% CI 0.919–0.979; 1-year: HR 0.967, 95% CI 0.943–0.991), eGFR by CKD-EPI (90-day: HR 0.948, 95% CI 0.915–0.983; 1-year: HR 0.971, 95% CI 0.945–0.998) were found to be independent predictors of mortality. eGFR by MDRD, D-dimer, and PESI value were significant prognostic factors for 90-day mortality. Conclusion: Decreased renal function is a prognostic factor for increased all-cause mortality 90 days and 1 year after acute PE.

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Practice patterns of retrievable inferior vena cava filters and predictors of filter retrieval in patients with pulmonary embolism

Vascular Medicine ◽

10.1177/1358863x17726596 ◽

2017 ◽

Vol 22 (6) ◽

pp. 512-517 ◽

Cited By ~ 2

Author(s):

Jieun Kang ◽

Heung-Kyu Ko ◽

Ji Hoon Shin ◽

Gi-Young Ko ◽

Kyung-Wook Jo ◽

...

Keyword(s):

Pulmonary Embolism ◽

Inferior Vena Cava ◽

Predictive Factors ◽

Inferior Vena ◽

Vena Cava ◽

Ivc Filter ◽

Retrieval Rate ◽

Filter Retrieval ◽

Ivc Filters ◽

Filter Insertion

Retrievable inferior vena cava (IVC) filters are increasingly used in patients with venous thromboembolism (VTE) who have contraindications to anticoagulant therapy. However, previous studies have shown that many retrievable filters are left permanently in patients. This study aimed to identify the common indications for IVC filter insertion, the filter retrieval rate, and the predictive factors for filter retrieval attempts. To this end, a retrospective cohort study was performed at a tertiary care center in South Korea between January 2010 and May 2016. Electronic medical charts were reviewed for patients with pulmonary embolism (PE) who underwent IVC filter insertion. A total of 439 cases were reviewed. The most common indication for filter insertion was a preoperative/procedural aim, followed by extensive iliofemoral deep vein thrombosis (DVT). Retrieval of the IVC filter was attempted in 44.9% of patients. The retrieval success rate was 93.9%. History of cerebral hemorrhage, malignancy, and admission to a nonsurgical department were the significant predictive factors of a lower retrieval attempt rate in multivariate analysis. With the increased use of IVC filters, more issues should be addressed before placing a filter and physicians should attempt to improve the filter retrieval rate.

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Short- and Long-Term Outcomes of Catheter-Directed Thrombolysis versus Pulmonary Artery Embolectomy in Pulmonary Embolism: A National Population-Based Study

Journal of Endovascular Therapy ◽

10.1177/15266028211054763 ◽

2021 ◽

pp. 152660282110547

Author(s):

Donna Shu-Han Lin ◽

Yu-Sheng Lin ◽

Jen-Kuang Lee ◽

Wen-Jone Chen

Keyword(s):

Pulmonary Embolism ◽

Pulmonary Artery ◽

Hazard Ratio ◽

Hospital Death ◽

Research Database ◽

Old Patients ◽

Catheter Directed Thrombolysis ◽

All Cause Mortality

Objectives: This study aimed to compare the short-term and long-term follow-up outcomes of catheter-directed thrombolysis (CDT) with those of pulmonary artery embolectomy (PAE) for patients with acute pulmonary embolism (PE) included in a nationwide cohort. Background: Data allowing direct comparisons between CDT and PAE are lacking in the literature, and the optimal management of high-risk and intermediate-risk PE is still debated. Methods: A retrospective cohort study was conducted with data for 2001 through 2013 collected from the Taiwan National Health Insurance Research Database (NHIRD). Patients who were first admitted for PE and treated with either CDT or PAE were included and compared. In-hospital outcomes included in-hospital death and safety (bleeding and cardiac arrhythmias) outcomes. Follow-up outcomes included all-cause mortality and recurrent PE during the 1- and 2-year follow-up periods and through the last follow-up. Inverse probability of treatment weighting (IPTW) based on the propensity score was used to minimize possible selection bias, including indices for multimorbidity such as the Charlson’s Comorbidity Index (CCI) and HAS-BLED scores. Results: A total of 389 patients treated between January 1, 2001, and December 31, 2013, were identified; 169 underwent CDT and 220 underwent PAE. After IPTW, there were no significant differences in in-hospital mortality (18.2% vs 21.3%; odds ratio 1.07, 95% confidence interval [CI]: 0.70–1.62) or the incidence of safety outcomes between the CDT and PAE groups. The risks of all-cause mortality (30% vs 29.5%; hazard ratio 1.16, 95% CI: 0.89–1.53), recurrent PE (7.2% vs 8.7%; subdistribution hazard ratio [SHR] 0.68, 95% CI: 0.39–1.21) and new-onset pulmonary hypertension (SHR 0.25, 95% CI: 0.05–1.32) were also not significantly different between the CDT and PAE groups at 2 years of follow-up. Subgroup analysis indicated that PAE may be associated with a more favorable 2-year mortality in patients <65 years old, patients with CCI scores of <3, patients with HAS-BLED scores of 1 to 2, and patients without cardiogenic shock (all P for interaction <.05). Conclusions: In patients with PE who required reperfusion therapy, CDT and PAE resulted in similar in-hospital and long-term all-cause mortality rates and long-term rates of recurrent PE. Bleeding risks were also comparable in the 2 groups.

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P0792FAT ATTENUATION INDEX OF CORONARY ARTERY IN COMPUTED TOMOGRAPHY ANGIOGRAPHY PREDICTS LONG-TERM OUTCOME IN CHRONIC KIDNEY DISEASE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0792 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Nam-Jun Cho ◽

Soon hyo Kwon ◽

Bo Da Nam ◽

Kyoungin Choi

Keyword(s):

Coronary Artery ◽

Kidney Disease ◽

Term Outcome ◽

Long Term Outcome ◽

Adjusted Risk ◽

Attenuation Index ◽

All Cause Mortality ◽

Long Term Mortality

Abstract Background and Aims Perivascular fat attenuation index (FAI) of coronary artery represents the degree of coronary inflammation. High coronary artery FAI in computed tomography angiography (CTA) is associated with increased all-cause and cardiac mortality in general population. However, the ability of the perivascular FAI using coronary CTA to predict long term outcome in chronic kidney disease (CKD) patients is unknown. Method This is a single center retrospective study. We analyzed coronary FAIs on CTA for CKD including patients with end stage renal disease (ESRD). The patients with percutaneous coronary intervention or coronary artery bypass graft were excluded. Mapping and analysis of perivascular FAI were performed around proximal three major coronary arteries. We assessed the prognostic value of FAI of CTA for long-term mortality (data from the Korean National Statistical Office) with Cox regression models, adjusted for age, sex, dialysis vintage, and clinical parameters. Results Between January 2012 and June 2018, 268 CKD patients were included. Mean age of this cohort was 64.5 ± 12.0 years, and 132 (49.3%) participants were men. 109 (44.7%) participants has diabetic kidney disease, and 179 (66.4%) participants were on hemodialysis. Median follow-up after coronary CTA was 29.2 (15.1 − 46.3) months. During follow-up, there were 43 (20.6%) deaths. The optimum cut-off value of FAI around the left anterior descending artery (LAD) was ascertained as -65.5 Hounsfield unit. The high perivascular FAI around the LAD was significantly associated with higher adjusted risk of all-cause mortality (hazard ratio, 2.15; 95% CI, 1.07–4.32). In ESRD subgroup, the high perivascular FAI group also has higher adjusted risk of all-cause mortality compared to low perivascular FAI group (hazard ratio, 2.43; 95% CI, 1.16–5.09). Conclusion The perivascular FAI around LAD predicts the long-term mortality in patients with CKD. This could provide the chance of early primary intervention in CKD patients.

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P1855Multiple and posterior location of moderate paravalvular leaks are associated with worse long-term outcome after successful TAVR

European Heart Journal ◽

10.1093/eurheartj/ehz748.0606 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

L Kalinczuk ◽

Z Chmielak ◽

K Zielinski ◽

G S Mintz ◽

M Dabrowski ◽

...

Keyword(s):

Clinical Importance ◽

Mortality Rates ◽

Paravalvular Leak ◽

Single Center ◽

Term Outcome ◽

Long Term Outcome ◽

Common Location ◽

Long Term Mortality

Abstract Background Posterior location of a paravalvular leak (PVL) affects left ventricle fluid dynamics in a more unfavorable way than leaks of the other locations. Purpose To assess impact of the PVL location and its grade on subsequent long term mortality after successful TAVR. Methods Out of 445 consecutive patients treated between 8/2009 and 10/2017 within the single-center, prospective TAVR Registry, there were 432 pts [median 83.0 years of age, 63.4% female] with device success (97.1%) as per VARC-2. Post-procedural TTE studies done within 7 days post-TAVR were analyzed for PVL location (anterior vs posterior vs medial vs lateral) and grade (none/trace/mild vs moderate). Long-term mortality was assessed. Results Median follow-up was 29.3 (15.8–53.1) months with 1-year follow-up in all pts. The 30-day and 1-year mortality rates were 3.0% (n=13) and 13.4% (n=58) with an estimated 4-year mortality of 35.5%. Moderate PVL was reported in 28.5% (n=123) of pts, with 12.0% (n=52) having multiple locations (>1 PVL). Among moderate PVLs (n=184), most were of anterior (33.2%), 29.3% were posterior, 25.2% were lateral, and the least common location was medial (12.0%). Whereas moderate PVL alone was not associated with worse long-term outcome, the 1-year mortality rates tended to be higher for pts with PVL found at multiple or posterior locations (19.2% vs 12.6% among the rest of the subjects, p=0.20, and 18.5% vs 12.7%, p=0.28, respectively). The KM curves suggest mid-term clinical importance of multiple or posterior PVLs (Fig 1A and 1B). Figure 1 Conclusions Moderate PVL found in multiple locations or recognized in the posterior location tend to be associated with worse midterm (1–2 years) prognosis after successful TAVR.

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Long-term results of low-dose tissue plasminogen activator therapy in acute pulmonary embolism

Journal of Investigative Medicine ◽

10.1136/jim-2019-001042 ◽

2019 ◽

Vol 67 (8) ◽

pp. 1142-1147

Author(s):

Habibe Hezer ◽

Hatice Kiliç ◽

Osama Abuzaina ◽

H Canan Hasanoǧlu‎ ◽

Ayşegül Karalezli

Keyword(s):

Thrombolytic Therapy ◽

Low Dose ◽

Standard Dose ◽

Mortality Rates ◽

Tissue Plasminogen ◽

Long Term Follow Up ◽

Acute Pe ◽

Overall Mortality

Recombinant tissue plasminogen activator (rt-PA) is the most commonly used thrombolytic agent in patients with high risk and intermediate to high mortality risk acute pulmonary embolism (PE). Clinical trials have shown early efficacy and safety of low-dose rt-PA. This study investigated the effects of low-dose rt-PA treatment on acute PE in long-term prognosis, recurrence of pulmonary thromboembolism, or the development of late complications. In this study, 48 patients undergoing low-dose rt-PA for the relative contraindications of thrombolytic therapy and 48 patients undergoing standard-dose therapy were evaluated retrospectively. Long-term follow-up investigated the chronic PE, recurrence, and causes of morbidity and mortality.In both treatment groups, embolism-induced mortality and overall mortality rates were similar in the first 30 days (p=1.000, p=0.714, respectively). Overall mortality rates in long-term follow-up were 41.7% in the low-dose treatment group and 16.7% in the standard-dose treatment group (p=0.013). The mortality rate at the first year was higher in the low-dose-treated group (p=0.011) and most of the deaths were due to accompanying comorbidities. There was no difference in PE recurrence and duration of recurrence between the groups (p=0.598, p=0.073, respectively). Intracranial hemorrhage due to therapy developed in one patient in both groups.Low-dose thrombolytic therapy in acute PE reduces PE-related mortality in the early period. Long-term follow-up showed that thrombolytic therapy did not affect mortality rates independently of the dose and PE recurrence.

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Differences in mortality and suicidal behaviour between treated and never-treated people with schizophrenia in rural China

The British Journal of Psychiatry ◽

10.1192/bjp.bp.108.055301 ◽

2009 ◽

Vol 195 (2) ◽

pp. 126-131 ◽

Cited By ~ 28

Author(s):

Mao-Sheng Ran ◽

Cecilia Lai-Wan Chan ◽

Eric Yu-Hai Chen ◽

Wen-Jun Mao ◽

Shi-Hui Hu ◽

...

Keyword(s):

Suicidal Behaviour ◽

Rural China ◽

Middle Income ◽

Follow Up Study ◽

Duration Of Illness ◽

All Cause Mortality ◽

Mortality Ratio ◽

Long Term Mortality

BackgroundMany people with schizophrenia remain untreated in the community. Long-term mortality and suicidal behaviour among never-treated individuals with schizophrenia in the community are unknown.AimsTo explore 10-year mortality and suicidal behaviour among never-treated individuals with schizophrenia.MethodWe used data from a 10-year prospective follow-up study (1994–2004) among people with schizophrenia in Xinjin County, Chengdu, China.ResultsThe mortality rate for never-treated individuals with schizophrenia was 2761 per 100 000 person-years during follow-up. There were no significant differences of rates of suicide and all-cause mortality between never-treated and treated individuals. The standardised mortality ratio (SMR) for never-treated people was 10.4 (95% CI 7.2–15.2) and for treated individuals 6.5 (95% CI 5.2–8.5). Compared with treated people, never-treated individuals were more likely to be older, poorer, have a longer duration of illness, marked symptoms and fewer family members.ConclusionsThe never-treated individuals have similar mortality to and a higher proportion of marked symptoms than treated people, which may reflect the poor outcome of the individuals without treatment. The higher rates of mortality, homelessness and never being treated among people with schizophrenia in low- and middle-income nations might challenge presumed wisdom about schizophrenia outcomes in these countries.

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Joint analysis of D-dimer, N-terminal pro b-type natriuretic peptide, and cardiac troponin I on predicting acute pulmonary embolism relapse and mortality

Scientific Reports ◽

10.1038/s41598-021-94346-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Xiaoyu Liu ◽

Liying Zheng ◽

Jing Han ◽

Lu Song ◽

Hemei Geng ◽

...

Keyword(s):

Pulmonary Embolism ◽

Survival Rate ◽

Adverse Events ◽

Acute Pulmonary Embolism ◽

Troponin I ◽

All Cause Mortality ◽

Long Term Prognosis ◽

D Dimer

AbstractPrevious studies on the adverse events of acute pulmonary embolism (APE) were mostly limited to single marker, and short follow-up duration, from hospitalization to up to 30 days. We aimed to predict the long-term prognosis of patients with APE by joint assessment of D-dimer, N-Terminal Pro-Brain Natriuretic Peptide (NT-ProBNP), and troponin I (cTnI). Newly diagnosed patients of APE from January 2011 to December 2015 were recruited from three hospitals. Medical information of the patients was collected retrospectively by reviewing medical records. Adverse events (APE recurrence and all-cause mortality) of all enrolled patients were followed up via telephone. D-dimer > 0.50 mg/L, NT-ProBNP > 500 pg/mL, and cTnI > 0.40 ng/mL were defined as the abnormal. Kaplan–Meier curve was used to compare the cumulative survival rate between patients with different numbers of abnormal markers. Cox proportional hazard regression model was used to further test the association between numbers of abnormal markers and long-term prognosis of patients with APE after adjusting for potential confounding. During follow-up, APE recurrence and all-cause mortality happened in 78 (30.1%) patients. The proportion of APE recurrence and death in one abnormal marker, two abnormal markers, and three abnormal markers groups were 7.69%, 28.21%, and 64.10% respectively. Patients with three abnormal markers had the lowest survival rate than those with one or two abnormal markers (Log-rank test, P < 0.001). After adjustment, patients with two or three abnormal markers had a significantly higher risk of the total adverse event compared to those with one abnormal marker. The hazard ratios (95% confidence interval) were 6.27 (3.24, 12.12) and 10.7 (4.1, 28.0), respectively. Separate analyses for APE recurrence and all-cause death found similar results. A joint test of abnormal D-dimer, NT-ProBNP, and cTnI in APE patients could better predict the long-term risk of APE recurrence and all-cause mortality.

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