Clinical features and short-term outcomes of cancer patients with suspected and unsuspected pulmonary embolism: the EPIPHANY study

Abstract

The study aimed to identify predictors of overall 30-day mortality in cancer patients with pulmonary embolism including suspected pulmonary embolism (SPE) and unsuspected pulmonary embolism (UPE) events. Secondary outcomes included 30- and 90-day major bleeding and venous thromboembolism (VTE) recurrence.The study cohort included 1033 consecutive patients with pulmonary embolism from the multicentre observational ambispective EPIPHANY study (March 2006-October 2014). A subgroup of 497 patients prospectively assessed for the study were subclassified into three work-up scenarios (SPE, truly asymptomatic UPE and UPE with symptoms) to assess outcomes.The overall 30-day mortality rate was 14%. The following variables were associated with the overall 30-day mortality on multivariate analysis: VTE history, upper gastrointestinal cancers, metastatic disease, cancer progression, performance status, arterial hypotension <100 mmHg, heart rate >110 beats·min, basal oxygen saturation <90% and SPE (versus overall UPE).The overall 30-day mortality was significantly lower in patients with truly asymptomatic UPE events (3%) compared with those with UPE-S (20%) and SPE (21%) (p<0.0001). Thirty- and 90-day VTE recurrence and major bleeding rates were similar in all the groups.In conclusion, variables associated with the severity of cancer and pulmonary embolism were associated with short-term mortality. Our findings may help to develop pulmonary embolism risk-assessment models in this setting.

Reducing the hospital burden associated with the treatment of pulmonary embolism

“…Analysis of data from the observational EPIPHANY study shows that patients with unsuspected PE who are truly asymptomatic (not hospitalized at the time of diagnosis and with no PE‐related symptoms and normal vital signs) have a significantly lower 30‐day mortality (3%) than both patients with unsuspected PE who were subsequently found to have symptoms of PE on clinical evaluation (20%) and patients with suspected PE (i.e. CT‐imaging performed to confirm PE diagnosis; 21%) []. These findings are supported by data from two single‐center studies (one prospective and one retrospective) showing good outcomes in patients with incidental PE treated at home (Table ).…”

“…With the widespread utilization of CT imaging to monitor cancer progression, ~50% of patients with cancer diagnosed with PE in specialist oncology centers have “incidental” or “unsuspected” PE (i.e. imaging performed for reasons other than PE suspicion) . Analysis of data from the observational EPIPHANY study shows that patients with unsuspected PE who are truly asymptomatic (not hospitalized at the time of diagnosis and with no PE‐related symptoms and normal vital signs) have a significantly lower 30‐day mortality (3%) than both patients with unsuspected PE who were subsequently found to have symptoms of PE on clinical evaluation (20%) and patients with suspected PE (i.e.…”

Symptoms, signs, suspicion and setting: a PESI score for cancer-associated pulmonary embolism?

“…In conclusion, this large cohort study by FONT et al [6] sheds new light on the contemporary clinical course of suspected and unsuspected cancer-associated PE. Within the limitations of an observational study, the authors presented a novel cancer-associated PE risk classification that discriminates between a patient group with UPE without symptom burden (TA-UPE) who experienced a 30-day risk of death of only 3%, and all other patients who experienced 30-day risk of death of around 20%.…”

“…These tools are based on short-term mortality, with a higher predicted risk of short-term mortality indicating that an inpatient management is preferred. FONT et al [6] have addressed this short-term mortality specifically in the population of cancer patients with PE. Importantly, they defined a novel classification, which shows that patients with a so-called TA-UPE had only a much smaller risk of 30-day mortality of 3%, whereas all other patients (either presenting with SPE or UPE with symptoms/signs suggestive of PE (UPE-S)) had a 30-day risk of death of around 20%.…”

Incidental venous thromboembolism, detected by chance, but still venous thromboembolism

“…In the EPIPHANY study, patients with cancer and PE were divided into three groups, those with clinically suspected PE, those with clinically unsuspected PE and no symptoms attributable to PE, and a third group with clinically unsuspected PE who retrospectively had symptoms related to PE. Patients with clinically suspected PE were more likely to have a syncope or a heart rate >100 beats per min than symptomatic patients with clinically unsuspected PE, but 90-day mortality rates were comparable in these two groups and higher than in the group of asymptomatic patients [6].…”