Publication
Risk stratification in normotensive acute pulmonary embolism patients: focus on the intermediate-high risk subgroup
| dc.contributor.author | Santos, AR | |
| dc.contributor.author | Freitas, P | |
| dc.contributor.author | Ferreira, J | |
| dc.contributor.author | Faria, D, et al. | |
| dc.date.accessioned | 2019-05-08T14:37:44Z | |
| dc.date.available | 2019-05-08T14:37:44Z | |
| dc.date.issued | 2019 | |
| dc.description.abstract | BACKGROUND: Patients with acute pulmonary embolism are at intermediate-high risk in the presence of imaging signs of right ventricular dysfunction plus one or more elevated cardiac biomarker. We hypothesised that intermediate-high risk patients with two elevated cardiac biomarkers and imaging signs of right ventricular dysfunction have a worse prognosis than those with one cardiac biomarker and imaging signs of right ventricular dysfunction. METHODS: We analysed the cumulative presence of cardiac biomarkers and imaging signs of right ventricular dysfunction in 525 patients with intermediate risk pulmonary embolism (intermediate-high risk = 237) presenting at the emergency department in two centres. Studied endpoints were composites of all-cause mortality and/or rescue thrombolysis at 30 days (primary endpoint; n=58) and pulmonary embolism-related mortality and/or rescue thrombolysis at 30 days (secondary endpoint; n=40). RESULTS: Patients who experienced the primary endpoint showed a higher proportion of elevated troponin (47% vs. 76%, P<0.001), elevated N-terminal pro-brain natriuretic peptide (67% vs. 93%, P<0.001) and imaging signs of right ventricular dysfunction (47% vs. 80%, P<0.001). Multivariate analysis revealed N-terminal pro-brain natriuretic peptide (hazard ratio (HR) 3.6, 95% confidence interval (CI) 1.3-10.3; P=0.015) and imaging signs of right ventricular dysfunction (HR 2.8, 95% CI 1.5-5.2; P=0.001) as independent predictors of events. In the intermediate-high risk group, patients with two cardiac biomarkers performed worse than those with one cardiac biomarker (HR 3.3, 95% CI 1.8-6.2; P=0.003). CONCLUSIONS: Risk stratification in normotensive pulmonary embolism should consider the cumulative presence of cardiac biomarkers and imaging signs of right ventricular dysfunction, especially in the intermediate-high risk subgroup. | pt_PT |
| dc.description.version | info:eu-repo/semantics/publishedVersion | pt_PT |
| dc.identifier.citation | Eur Heart J Acute Cardiovasc Care. 2019 Apr 24:2048872619846506 | pt_PT |
| dc.identifier.doi | 10.1177/2048872619846506 | pt_PT |
| dc.identifier.issn | 2048-8734 | |
| dc.identifier.uri | http://hdl.handle.net/10400.10/2231 | |
| dc.language.iso | eng | pt_PT |
| dc.peerreviewed | yes | pt_PT |
| dc.publisher | SAGE Publications | pt_PT |
| dc.subject | Pulmonary embolism | pt_PT |
| dc.subject | Risk assessment | pt_PT |
| dc.title | Risk stratification in normotensive acute pulmonary embolism patients: focus on the intermediate-high risk subgroup | pt_PT |
| dc.type | journal article | |
| dspace.entity.type | Publication | |
| oaire.citation.conferencePlace | London | pt_PT |
| oaire.citation.title | European Heart Journal: Acute Cardiovascular Care | pt_PT |
| rcaap.rights | closedAccess | pt_PT |
| rcaap.type | article | pt_PT |
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