Acute pulmonary embolism (PE) is a fatal condition when untreated. Long term prognosis of acute PE in the 21st century has not been fully reported. We aimed to determine the long-term prognosis of acute PE and assess if there were survival differences between patients with idiopathic and secondary PE.
We retrospectively analysed a cohort of patients hospitalized with acute PE between 2006 and 2013. Excluded: 1) <18 years old, 2) embolism of non-pulmonary veins and 3) chronic pulmonary embolism. The vital status was ascertained by consulting the National Registry of Portuguese Patients platform. Patients were grouped according to acute PE aetiology: idiopathic, secondary to a neoplastic condition and secondary to conditions other than a neoplasia. A Cox-regression analysis was used to study the prognostic implications of PE aetiology. Multivariate models were built.
A total of 872 patients with acute PE were admitted, median age: 70 years old, 496 (56.9%) were female. In 36.8% the PE was of central arteries and in 56.9% bilateral. PE was considered idiopathic in 376 (43.1%), secondary to a neoplastic condition in 284 (32.6%) and secondary to a condition other than neoplasia in 212 (24.3%). Patients were followed for a median period of 25 months and 508 (58.3%) patients died. Patients with acute PE attributed to a neoplastic condition had the worst survival and those with PE secondary to a non-neoplastic condition the best survival. Patients with idiopathic PE had a multivariate adjusted HR of mortality of 1.46 (1.08-1.99) during the over 2-year follow-up period when compared to those with acute PE secondary to a non-neoplastic condition.
Acute PE attributed to a neoplasia portended the worst prognosis. Patients with idiopathic PE had 46% higher risk of death than those with PE secondary to a non-neoplastic condition. Idiopathic PE should probably be looked at more carefully by physicians treating acute PE patients.
Clinical trial identification
Legal entity responsible for the study
Hospital Centre of São João.
Has not received any funding.
All authors have declared no conflicts of interest.