ORIGINAL ARTICLES   

International Angiology 2016 April;35(2):184-91

Copyright © 2016 EDIZIONI MINERVA MEDICA

language: English

Typical symptoms for prediction of outcome and risk stratification in acute pulmonary embolism

Karsten KELLER ^{1, 2}, Johannes BEULE ³, Joern O. BALZER ^{4, 5}, Wolfgang DIPPOLD ³ ✉

¹ Department of Medicine II, University Medical Center Mainz, Mainz, Germany; ² Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany (Johannes Gutenberg-University Mainz); ³ Department of Internal Medicine, St. Vincenz and Elisabeth Hospital Mainz, Mainz, Germany; ⁴ Department of Radiology and Nuclear Medicine, Catholic Clinic Mainz, Mainz, Germany; ⁵ Department of Diagnostic and Interventional Radiology, University Clinic, Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany

BACKGROUND: Clinical presentation of pulmonary embolism (PE) comprises a wide spectrum from asymptomatic incidental finding to typical symptoms with chest pain, dyspnea, hemoptysis and syncope/collapse. We aimed to investigate typical symptoms of PE and increasing number of these symptoms to predict outcome in acute PE.
METHODS: Data of PE patients were analysed retrospectively. According to the typical symptoms patients were subdivided in groups with 0, 1, 2, or ≥3 symptoms, which were compared with Kruskal-Wallis-Test. Logistic regression models were computed to investigate the association between the symptoms as well as the groups with the outcome parameters in-hospital death, myocardial necrosis, Shock-Index ≥1.0 and (right ventricular dysfunction (RVD). ROC curves were calculated to test the effectiveness of increasing number of symptoms to predict the outcome parameters.
RESULTS: One hundred eighty-two PE patients (61.5% female, mean age 68.5±15.3 years) were included in this study. 5 patients (2.7%) died in-hospital. Logistic regression models revealed associations between syncope/collapse and in-hospital death (OR 7.269, 95%CI 0.894-59.130, P=0.0636), myocardial necrosis (OR2.872, 0.904-9.130, P=0.0738), Shock-Index ≥1.0 (OR 4.906, 1.440-16.721, P=0.00110) and RVD (OR 5.265, 1.078-25.708, P=0.0401). Dyspnea and myocardial necrosis were also associated (OR 3.245, 1.127-9.348, P=0.0292). Increasing number of symptoms were not associated with in-hospital death, but absence of typical symptoms was associated with lower frequency of myocardial necrosis (OR 0.212, 0.046-0.976, P=0.0464). Effectiveness of increasing number of symptoms to predict myocardial necrosis was only moderate (AUC 0.608).
CONCLUSIONS: The symptom syncope/collapse is connected with poorer outcome in acute PE. An increasing number of symptoms failed to be useful for outcome prediction and risk stratification in acute PE.