open access

Vol 67, No 7 (2009)
Other
Published online: 2009-07-17
Submitted: 2012-12-28
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Original article
Acute pulmonary embolism registry in the Małopolska region – clinical course

Piotr Kukla, Leszek Bryniarski, Robert Długopolski, Ewa Krupa, Jacek Nowak, Łukasz Kulak, Ewa Mirek-Bryniarska, Agnieszka Nowicka, Jerzy Hybel, Kazimierz Szczuka
Kardiol Pol 2009;67(7):735-741.

open access

Vol 67, No 7 (2009)
Other
Published online: 2009-07-17
Submitted: 2012-12-28

Abstract

Background: Acute pulmonary embolism (APE) is a life-threatening disease. Mortality in APE still remains very high in spite of progress in diagnostic tools. Mortality rate is about 30% in patients with unrecognised APE. APE is one of the main causes of in-hospital mortality. Aim: To asses management of patients with APE in the Małopolska region.
Methods: This registry consists of 205 consecutive patients who were hospitalised in 6 cardiology departments between 1 January 2005 and 30 September 2007, with the mean age of 65.1 ± 15.3 years (124 females and 81 males). Mean hospitalisation duration 14.6 days (1-52 days).
Results: During hospitalisation 23 (11.2%) patients died. Complications (death, cardiogenic shock, cardiac arrest, use of catecholamines, respiratory therapy and ventilation) during in-hospital stay were observed in 57 (27.8%) patients. Fifty-three patients were haemodynamically unstable (cardiogenic shock or hypotension). The troponin I or T level was assessed in 147 (71.7%) patients and in 50 (34.0%) was positive. In patients with positive troponin we observed 11 (22.0%) deaths, while in patients with normal troponin T or I level 6 (6.2%) deaths occurred. In patients with normal blood pressure we observed a significant difference in mortality in patients with elevated vs. normal troponin level (14.3 vs. 2.5%, p = 0.02). Thrombolytic therapy was used in 20 (9.8%) patients. In patients treated with thrombolytic therapy 9 (45%) deaths were observed. We divided patients according to the ESC 2008 guidelines risk stratification. The ‘non-high risk’ group consisted of 152 (74.1%) patients, and mortality was 3.9%. The ‘high-risk’ group consisted of 53 (26.8%) patients. The ‘non-high risk’ group was divided into the following subgroups: 1. moderate-high (with 2 risk factors: both RV dysfunction and positive injury markers) mortality – 8.1%; 2. moderate subgroup with one risk factor, mortality – 3.6%; 3. low risk – no risk factors – 0% mortality.
Conclusions: 1. In our registry mortality rate in patients with APE was 11%. 2. In about 30% of patients APE was under mask of acute coronary syndrome or syncope, 34% of patients had elevated troponin level, and 30% of patients had complication during hospitalisation. 3. In patients treated with thrombolytics mortality rate was 45%. 4. Reperfusion strategy (trombolysis or embolectomy) in the high risk group was used in only 41% of patients. 5. Elevated troponin level in normotensive patient was associated with 4-fold times higher risk of death. 6. New risk stratification according to the ESC guidelines 2008 correctly predicts prognosis in everyday clinical practise.

Abstract

Background: Acute pulmonary embolism (APE) is a life-threatening disease. Mortality in APE still remains very high in spite of progress in diagnostic tools. Mortality rate is about 30% in patients with unrecognised APE. APE is one of the main causes of in-hospital mortality. Aim: To asses management of patients with APE in the Małopolska region.
Methods: This registry consists of 205 consecutive patients who were hospitalised in 6 cardiology departments between 1 January 2005 and 30 September 2007, with the mean age of 65.1 ± 15.3 years (124 females and 81 males). Mean hospitalisation duration 14.6 days (1-52 days).
Results: During hospitalisation 23 (11.2%) patients died. Complications (death, cardiogenic shock, cardiac arrest, use of catecholamines, respiratory therapy and ventilation) during in-hospital stay were observed in 57 (27.8%) patients. Fifty-three patients were haemodynamically unstable (cardiogenic shock or hypotension). The troponin I or T level was assessed in 147 (71.7%) patients and in 50 (34.0%) was positive. In patients with positive troponin we observed 11 (22.0%) deaths, while in patients with normal troponin T or I level 6 (6.2%) deaths occurred. In patients with normal blood pressure we observed a significant difference in mortality in patients with elevated vs. normal troponin level (14.3 vs. 2.5%, p = 0.02). Thrombolytic therapy was used in 20 (9.8%) patients. In patients treated with thrombolytic therapy 9 (45%) deaths were observed. We divided patients according to the ESC 2008 guidelines risk stratification. The ‘non-high risk’ group consisted of 152 (74.1%) patients, and mortality was 3.9%. The ‘high-risk’ group consisted of 53 (26.8%) patients. The ‘non-high risk’ group was divided into the following subgroups: 1. moderate-high (with 2 risk factors: both RV dysfunction and positive injury markers) mortality – 8.1%; 2. moderate subgroup with one risk factor, mortality – 3.6%; 3. low risk – no risk factors – 0% mortality.
Conclusions: 1. In our registry mortality rate in patients with APE was 11%. 2. In about 30% of patients APE was under mask of acute coronary syndrome or syncope, 34% of patients had elevated troponin level, and 30% of patients had complication during hospitalisation. 3. In patients treated with thrombolytics mortality rate was 45%. 4. Reperfusion strategy (trombolysis or embolectomy) in the high risk group was used in only 41% of patients. 5. Elevated troponin level in normotensive patient was associated with 4-fold times higher risk of death. 6. New risk stratification according to the ESC guidelines 2008 correctly predicts prognosis in everyday clinical practise.
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Keywords

acute pulmonary embolism; mortality; risk stratification; troponin

About this article
Title

Original article
Acute pulmonary embolism registry in the Małopolska region – clinical course

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 67, No 7 (2009)

Pages

735-741

Published online

2009-07-17

Bibliographic record

Kardiol Pol 2009;67(7):735-741.

Keywords

acute pulmonary embolism
mortality
risk stratification
troponin

Authors

Piotr Kukla
Leszek Bryniarski
Robert Długopolski
Ewa Krupa
Jacek Nowak
Łukasz Kulak
Ewa Mirek-Bryniarska
Agnieszka Nowicka
Jerzy Hybel
Kazimierz Szczuka

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