A retrospective observational study on prognostic factors in intermediate-high risk pulmonary embolism patients.

Pulmonary embolism (PE) is a common acute cardiovascular syndrome worldwide. Various environmental and genetic factors predispose to PE. Right ventricular (RV) failure is considered the cause of death. Risk stratification is mandatory for appropriate therapeutic management. According to ESC guidelines, intermediate-high risk PE is defined as hemodynamic stability, PESI class III–V or sPESI ≥1, RV dysfunction and elevated cardiac troponin (Tn) levels. While reperfusion treatment (mainly systemic thrombolysis) is recommended for high-risk PE (hemodynamic instability), its role in intermediate-high risk PE remains uncertain.

To perform a descriptive analysis of intermediate-high risk PE patients and to identify prognostic factors.

This is a retrospective observational study of all patients diagnosed with intermediate-high risk PE admitted to the ACCU of a tertiary hospital from September 2019 to March 2023. Demographic, clinical, analytical and cardiac imaging data were collected. Subsequently, a statistical analysis was performed using STATA software.

A total of 133 patients were included (mean age 66.1 ± 15.4 years; 58% male). Dyspnoea occurred in 84.3%, chest pain in 37.3% and syncope in 17.2%. Laboratory results showed mean values of D-dimer at 16,565 ± 18,380μg/L, TnI at 0.29 ± 0.46 ng/L, NT-proBNP at 3,600 ± 6,350pg/mL and lactate at 4.11 ± 6.4mmol/L. Echocardiographic parameters included mean TAPSE of 16.4 ± 4.3mm, mean RV S' wave of 10.4 ± 2.6mm, mean RV-RA gradient of 40.3mmHg and RV end-diastolic diameter of 40.3 ± 13.8mmHg; 70.3% had a RV/LV ratio > 1 and 81.5% displayed septal shift. The median hospitalization stay was 4 days, 2.54% suffered from haemorrhagic complications, 12.7% required Intensive Care Unit (ICU) admission and 3.76% passed away. Univariate logistic regression analysis revealed that NT-proBNP (OR 1,000087, p=0,044), TnI (OR 3.23, p=0.031), vasoactive support (OR 9.08, p=0.020) and systolic blood pressure (SBP) (OR 0.96, p=0.036) were significantly associated with mortality. Additionally, syncope (OR 5.35, p=0.049), TAPSE (OR 0.69, p=0.017), unfractionated heparin use (OR 13, p=0.021), systemic thrombolysis (OR 82, p=0.0001), vasoactive support (OR 12.82, p=0.005) and bleeding complications (OR 74.67, p=0.001) were significantly associated with ICU admission.

Elevated NT-proBNP and TnI levels, vasoactive support and lower SBP were associated with increased mortality. Syncope, lower TAPSE, vasoactive support and bleeding complications were associated with higher ICU admission rates. Our study highlights the importance of assessing clinical, analytical and cardiac imaging data in intermediate-high risk PE patients to potentially guide treatment strategies. Patients with the risk factors mentioned before could benefit from percutaneous catheter-directed treatment. Further research is required to validate this hypothesis.