Saddle pulmonary embolism: Is it as bad as it looks? A community hospital experience*

Sardi, Alejandro; Gluskin, Jill S.; Guttentag, Adam; Kotler, Morris N.; Braitman, Leonard E.; Lippmann, Michael

doi:10.1097/ccm.0b013e31822571b2

Cited by 52 publications

(31 citation statements)

References 28 publications

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“…This disparity probably reflects the fact that the present study was only conducted with patients at ED admission, whereas all of the previous studies also examined patients at non-ED admission. This fact is supported by the report by Sardi et al [12], in which 81% of the SE cases were diagnosed in the ED and another 19% developed SE during hospitalisation.…”

Section: Discussionsupporting

confidence: 78%

“…The SE frequency of 9.7% is slightly higher than the frequencies recorded by previous studies: Pruszczyk et al [9], Ryu et al [7] and Sardi et al [12] found frequencies of 5.2%, 2.6% and 5.4%, respectively. This disparity probably reflects the fact that the present study was only conducted with patients at ED admission, whereas all of the previous studies also examined patients at non-ED admission.…”

Section: Discussioncontrasting

confidence: 43%

“…Therefore, for appropriate risk stratification, it is necessary to know the prognosis of SE, especially in patients with non-high-risk acute PE. Recent studies have shown that the mortality rate associated with SE is low: none of the 14 patients with SE in the study by Ryu et al [7] died; 1 of the 17 patients in the study by Pruszczyk et al [9] died; 2 of the 37 patients in the study by Sardi et al [12] died; 2 of the 31 patients in the study by Gandara et al died [17]; and Vedovati et al [18] said that saddle emboli were not predictors of all-cause death or clinical deterioration. In all three studies, the mortality rates of the SE and non-SE groups did not differ significantly.…”

Section: Discussionmentioning

confidence: 98%

“…Full Paper: The impact of saddle embolism BJR with worse short-term outcomes [4,5,7,9,12]. Therefore, for appropriate risk stratification, it is necessary to know the prognosis of SE, especially in patients with non-high-risk acute PE.…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis of saddle PE causes clinical alarm because it signals an unstable, large clot burden in the pulmonary artery and the possibility of sudden haemodynamic collapse. Nonetheless, the clinical presentation and outcomes of these patients vary widely [9][10][11][12][13]. In particular, an unresolved issue is the prognosis of patients with SE in haemodynamically stable (non-high-risk) PE.…”

Section: Advances In Knowledgementioning

confidence: 99%

See 4 more Smart Citations

The impact of saddle embolism on the major adverse event rate of patients with non-high-risk pulmonary embolism

Kwak

Kim²,

Lee³

et al. 2013

BJR

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Objective: Wider application of CT angiography (CTA) improves the diagnosis of acute pulmonary embolism (PE). It also permits the visualisation of saddle embolism (SE), namely thrombi, which are located at the bifurcation of the main pulmonary artery. The aim of this study was to assess the prevalence of SE and whether SE predicts a complicated clinical course in patients with non-high-risk PE. Methods: In total, 297 consecutive patients with non-highrisk PE confirmed using CTA in the emergency department were studied. The presence of SE and its ability to predict the occurrence of major adverse events (MAEs) within 1 month were determined.

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Section: Discussionsupporting

confidence: 78%

Section: Discussioncontrasting

confidence: 43%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Advances In Knowledgementioning

confidence: 99%

See 3 more Smart Citations

The impact of saddle embolism on the major adverse event rate of patients with non-high-risk pulmonary embolism

Kwak

Kim²,

Lee³

et al. 2013

BJR

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Right Heart Failure from Pulmonary Embolism

Grover

Vaziri

Garcia

2020

Clinical Cases in Right Heart Failure

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Treatment of Submassive Pulmonary Embolism: Knowing When to be Aggressive and When to be Conservative

Ain

Jaff

2015

Curr Treat Options Cardio Med

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A patient who presents with pulmonary embolism (PE) but without hypotension should undergo risk stratification with echocardiography, computed tomography, and serum biomarker assessment. Submassive PE is identified by the findings of right ventricular dysfunction by physical examination or imaging, or by elevations in serum troponin or brain-type natriuretic peptide in the context of acute PE. Evidence of cardiac strain should prompt evaluation by a multidisciplinary team with experience in the management of submassive PE. Consideration of therapies beyond systemic anticoagulation, such as systemic intravenous thrombolysis, catheter-directed thrombolysis, and percutaneous or surgical embolectomy, must be based on the clinical presentation, the risk of adverse outcome, the skill of the operator, and the bleeding risk. Here, we address the current understanding of submassive PE, new insights into how established therapies alter the natural history of the disease process, and recent advances in treatment options.

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Saddle pulmonary embolism: Is it as bad as it looks? A community hospital experience*

Cited by 52 publications

References 28 publications

The impact of saddle embolism on the major adverse event rate of patients with non-high-risk pulmonary embolism

The impact of saddle embolism on the major adverse event rate of patients with non-high-risk pulmonary embolism

Right Heart Failure from Pulmonary Embolism

Treatment of Submassive Pulmonary Embolism: Knowing When to be Aggressive and When to be Conservative

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