Time trends in 30-day mortality in patients with pulmonary embolism

Type of funding sources: None.

There is a lack of evidence about recent mortality rates in patients with acute pulmonary embolism (PE).

To compare 30-day mortality between the current and historical cohort of patients treated for acute PE.

We provide a retrospective analysis of clinical and imaging features of 400 consecutive patients who were admitted to our hospital with the diagnosis of acute pulmonary embolism between February 2010 and April 2021. Patients with out-of-hospital cardiac arrest without return of spontaneous circulation (14 patients) were excluded from the study cohort. The 30-day mortality was compared between patients admitted before January 2016 (n =178) and after January 2016 (n = 222). We stratified patients into low-, intermediate-, and high-risk group according to the ‘2019 ESC Guidelines on Acute Pulmonary Embolism’.

The diagnosis of pulmonary embolism was based on results of computed tomography (86%), pulmonary ventilation/perfusion scan (7%), echocardiography (7%) and autopsy (1%).

Most patients were stratified as intermediate-risk (313 patients [78 %]), followed by low-risk (46 [12%]) and high-risk pulmonary embolism (41 [10%]).

The risk-stratification profile did not differ between the current and historical cohort (79% vs. 77% for intermediate-risk, 12% vs. 11% for low-risk, and 9% vs. 12% for high-risk patients, all p> 0.05).

Seventeen patients (4%) died within 30 days of admission to the hospital: ten patients in the high-risk (24%), seven in the intermediate-risk (2%), and none (0%) in the low-risk group (p <0.0001). There was no significant difference in 30-day mortality between the current and historical cohort (9 [4%] vs. 8 [4%], p = 0.83).

In a multivariate regression analysis, only the initial presence of cardiogenic shock was associated with higher 30-day mortality.

In-hospital mortality of patients with intermediate- and low-risk pulmonary embolism is lower than reported in the past and has not changed over the last decade. High-risk pulmonary embolism is associated with 24% 30-day mortality.