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Comparative clinical prognosis of massive and non‐massive pulmonary embolism: A registry‐based cohort study

2020; Elsevier BV; Volume: 19; Issue: 2 Linguagem: Inglês

10.1111/jth.15146

1538-7933

Marc Blondon, David Jiménez, Helia Robert‐Ebadi, J. del Toro, Luciano López-Jiménez, C. Falgá, Andris Skride, Llorenç Font, Fernando Javier Vázquez, Henri Bounameaux, Manuel Monréal, Paolo Prandoni, Benjamin Brenner, Dominique Farge, Raquel Barba, Pierpaolo Di Micco, Laurent Bertoletti, Sebastian Schellong, Inna Tzoran, Abílio Reis, Marijan Bosevski, Radován Malý, Peter Verhamme, Joseph A. Caprini, My Bui, M.D. Adarraga, María Agud, Jesús Aibar, M.A. Aibar, J Alfonso, Cristina Amado, J.I. Arcelus, Ciro Baeza, Aitor Ballaz, Raquel Barba, C. Barbagelata, M. Barrón, B. Barrón‐Andrés, Á. Blanco-Molina, Enrique Ramón Botella, A.M. Camón, Joaquín Castro, MA Caudevilla, Pau Cerdà, Leyre Chasco, Juan Criado, Cristina de Ancos, Javier de Miguel‐Díez, Pablo Demelo‐Rodríguez, J.A. Díaz‐Peromingo, J. Díez-Sierra, Raquel Díaz‐Simón, I.M. Domínguez, Mercedes Encabo, J.C. Escribano, C. Falgá, A.I. Farfán, Carmen Fernández‐Capitán, JL Fernández‐Reyes, MA Fidalgo, Katia Flores, Carme Font, Iria Francisco, Cristina Gabara, Francisco Galeano‐Valle, M.A. García, F. García‐Bragado, MM García‐Mullor, Olga Gavín-Blanco, Olga Gavín‐Sebastián, A. Gil-Díaz, Covadonga Gómez‐Cuervo, J. González‐Martínez, E Grau, L. Guirado, Juan Mata, Luis Blasco, Luis Jara‐Palomares, M.J. Jaras, David Jiménez, M.D. Joya, I. Jou, B. Lacruz, Ramón Lecumberri, Jorge Roberto Perrout de Lima, Lobo JL, Helena López-Brull, Luciano López-Jiménez, Patricia López-Miguel, J J López-Núñez, Raquel López-Reyes, J.B. López‐Sáez, M.A. Lorente, A. Lorenzo, Mónica Loring, Olga Madridano, Ana M. Maestre, P.J. Marchena, M. Martín del Pozo, F. Martín‐Martos, C. Martínez‐Baquerizo, C Mella, M Mellado, MI Mercado, Jorge Moisés, M.V. Morales, Arturo Muñoz Blanco, Diego Muñoz-Guglielmetti, A. Rivas, E Nart, J.A. Nieto, M C Nunez, M.C. Olivares, Clara Ortega‐Michel, M.D. Ortega-Recio, Jeisson Osorio, S. Otálora, Remedios Otero, Pedro Parra, Virginia Parra, JM Pedrajas, G. Pellejero, Asunción Pérez-Jacoiste, ML Peris, David Pesántez, JA Porras, José Portillo, Lluis Reig, A. Riera-Mestre, A. Rivas, A. Rodríguez-Cobo, Consolación Rodríguez-Matute, Jacobo Rogado, V. Rosa, CM Tauste Rubio, Pedro Ruiz‐Artacho, N. Ruiz‐Giménez, Justo Ruiz-Ruiz, Pablo Ruiz-Sada, J.C. Sahuquillo, G. Salgueiro, A. Sampériz, JF Sánchez‐Muñoz‐Torrero, Teresa Sancho, Patricia Sigüenza, Merçe Sirisi, S. Soler, Sara Busto Suárez, J.M. Suriñach, G Tiberio, MI Torres, Carles Tolosa, Javier Trujillo‐Santos, Fernando Uresandi, Esther Usandizaga, R. Valle, J. C. De Coll Vela, G. Vidal, Carlos Vilar, Paula Villares, C Zamora, Paula Gutiérrez, Francisco José Vázquez, Thomas Vanassche, Christophe Vandenbriele, Peter Verhamme, Jana Hirmerová, Radován Malý, E. Salgado, Ilham Benzidia, Laurent Bertoletti, A. Bura-Rivière, Benjamin Crichi, P. Debourdeau, Olivier Espitia, Dominique Farge, H. L. Helfer, I. Mahé, Farès Moustafa, Géraldine Poenou, Sebastian Schellong, Andrei Braester, Benjamin Brenner, Inna Tzoran, María Amitrano, Franca Bilora, Cristiano Bortoluzzi, B. Brandolin, Maurizio Ciammaichella, Donatella Colaizzo, Francesco Dentali, Pierpaolo Di Micco, Eliana Giammarino, Elvira Grandone, Sara Mangiacapra, Daniela Mastroiacovo, R. Maida, Nicola Mumoli, F. Pace, Raffaele Pesavento, Fulvio Pomero, Paolo Prandoni, Roberto Quintavalla, Anna Rocci, Carmine Siniscalchi, Antonella Tufano, A. Visonà, Ngoc Vo Hong, Beniamino Zalunardo, Verners Roberts Kalējs, Kristīne Maķe, Melanie Ferreira, S. Fonseca, Filipa Abreu Martins, J. Meireles, Marijan Bosevski, Marija Zdraveska, Lucia Mazzolai, J A Caprini, AJ Tafur, Ido Weinberg, Hannah Wilkins, HM Bui,

Acute Ischemic Stroke Management

AimsLittle is known about the prognosis of patients with massive pulmonary embolism (PE) and its risk of recurrent venous thromboembolism (VTE) compared with non‐massive PE, which may inform clinical decisions. Our aim was to compare the risk of recurrent VTE, bleeding, and mortality after massive and non‐massive PE during anticoagulation and after its discontinuation.Methods and resultsWe included all participants in the RIETE registry who suffered a symptomatic, objectively confirmed segmental or more central PE. Massive PE was defined by a systolic hypotension at clinical presentation (<90 mm Hg). We compared the risks of recurrent VTE, major bleeding, and mortality using time‐to‐event multivariable competing risk modeling. There were 3.5% of massive PE among 38 996 patients with PE. During the anticoagulation period, massive PE was associated with a greater risk of major bleeding (subhazard ratio [sHR] 1.72, 95% confidence interval [CI] 1.28–2.32), but not of recurrent VTE (sHR 1.15, 95% CI 0.75–1.74) than non‐massive PE. An increased risk of mortality was only observed in the first month after PE. After discontinuation of anticoagulation, among 11 579 patients, massive PE and non‐massive PE had similar risks of mortality, bleeding, and recurrent VTE (sHR 0.85, 95% CI 0.51–1.40), but with different case fatality of recurrent PE (11.1% versus 2.4%, P = .03) and possibly different risk of recurrent fatal PE (sHR 3.65, 95% CI 0.82–16.24).ConclusionIn this large prospective registry, the baseline hemodynamic status of the incident PE did not influence the risk of recurrent VTE, during and after the anticoagulation periods, but was possibly associated with recurrent PE of greater severity.