Association of risk stratification and mortality outcomes in patients of acute pulmonary embolism

Jit H. Brahmbhatt, Zeeshan H. Mansuri, Roopesh R. Singhal


Background: To study the association of risk stratification and mortality outcomes of patients with high/intermediate risk acute pulmonary embolism who are given the guideline directed therapy after the diagnosis of pulmonary embolism.

Methods: Prospective observational study of demographics, clinical profile, risk stratification, management and outcome of patients presenting with acute pulmonary embolism from October 2019to December 2020. Risk stratification was done as per ESC 2019 guidelines into high and intermediate categories, intermediate category patients were further stratified into intermediate-high and intermediate-low-risks.

Results: 100 patients who were detected to have acute pulmonary thromboembolism with a mean age of 45.08 years with 60% being males were included in the study. There were 31 patients in high-risk group, 59 patients in intermediate-high subgroup, 10 patients in intermediate-low subgroup. Echocardiography was done in all patients. Outcome was relatively grave in these subgroups with overall mortality of 56 patients. 49 patients were thrombolysed with rTPA, 27patients with alteplase, 4 patients with streptokinase, 12patients who had contraindication to systemic thrombolysis were subjected to catheter directed thrombolysis and 8 patients were taken up for surgical embolectomy.

Conclusions: Pulmonary embolism can present with unexplained dyspnea and atypical chest pain among other signs and symptoms. Early diagnosis, risk stratification and guideline directed prompt management can lead to favorable outcomes however; patients with high and intermediate risk at presentation are associated with higher mortality rate despite GDT.


Pulmonary embolism, Risk stratification, Mortality

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Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European respiratory society (ERS) the task force for the diagnosis and management of acute pulmonary embolism of the European society of cardiology (ESC). Eur Heart J. 2020;41(4):543-603.

Oger E. Incidence of venous thromboembolism: A community based study inWestern France. EPI GETBPStudy Group. Groupe d’Etude de la Thrombose de Bretagne Occidentale. Thromb Haemost 2000;83:657 60.

Martin C, Sobolewski K, Bridgeman P, Boutsikaris D. Systemic thrombolysis for pulmonary embolism: A Review. P T 2016;41:770 5.

Agarwal S, Lee AD, Raju RS, Stephen E. Venous thromboembolism: A problem in the Indian/Asian population? Indian J Urol. 2009;25:11 6.

Pawar P, Ayyappan MK, Jagan J, Rajendra N, Mathur K, Raju R. Analysis of patients with venous thromboembolism in a multi specialty tertiary hospital in South India. Indian J Vascular Endov Surg. 2020;7:29.

Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism: the task force for the diagnosis and management of acute pulmonary embolism of the European society of cardiology (ESC) endorsed by the European respiratory society (ERS). Europ Heart J. 2014;35:3033 80.

Anderson DR, Kovacs MJ, Dennie C, Kovacs G, Stiell I, Dreyer J, et al. Use of spiral computed tomography contrast angiography and ultrasonography to exclude the diagnosis of pulmonary embolism in the emergency department. J Emerg Med. 2005;29:399 404.

Kearon C, Ginsberg JS, Douketis J, Turpie AG, Bates SM, et al. An evaluation of D dimer in the diagnosis of pulmonary embol ism: A randomized trial. Ann Intern Med. 2006;144:812 21.

Rodger MA, Maser E, StiellI, Howley HE, Wells PS. The inter observer reliability of pretest probability assessment in patients with suspected pulmonary embolism. Thromb Res. 2005;116:101 7.

Stein PD, Beemath A, Matta F, Weg JG, Yusen RD, Hales CA, et al. Clinical characteristics of patients with acute pulmonary embolism: Data from PIOPED II. Am J Med. 2007;120:871 9.

Pinjala R, ENDORSE India investigators. Venous thromboembolism risk & prophylaxis in the acute hospital care setting (ENDORSE), a multinational cross sectionalstudy: Results from the Indian subset data. Indian J Med Res. 2012;136:60 7.

Davidsingh SC, Srinivasan N, Balaji P, Kalaichelvan U, Mullasari AS. Study of clinical profile and management of patients with pulmonary embolism–Single centerstudy. Indian Heart J. 2014;66(2):197-202.

Mitchell AM, Jones AE, Tumlin JA, Kline JA. Prospective study of the incidence of contrast-induced nephropathy among patients evaluated for pulmonary embolism by contrast-enhanced computed tomography. Acad Emerg Med. 2012;19:618 25.

Goldhaber SZ. Echocardiography in the management of pulmonary embolism. Arch Intern Med. 2002;136: 691e700.

Shukla AN, Thakkar B, Jayaram AA, Madan TH, Gandhi GD. Efficacy and safety of tenecteplase in pulmonary embolism. J Thromb Thrombolysis. 2014; 38:24 9.

Konstantinides SV, Vicaut E, Danays T, Becattini C, Bertoletti L, Beyer Westendorf J, et al. Impact of thrombolytic therapy on the long term outcome of intermediate risk pulmonary embolism. J Am Coll Cardiol. 2017;69:1536 44.

Konstantinides S, Geibel A, Heusel G, Heinrich F, Kasper W; Management Strategies and Prognosis of Pulmonary Embolism 3 Trial Investigators. Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism. N Engl J Med. 2002;347:1143 50.

Konstantinides SV, Barco S, Lankeit M, Meyer G. Management of pulmonary embolism: An update. J Am Coll Cardiol. 2016;67:976