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

Kwak, Mi Kyung; Kim, W Y; Lee, Choong Wook; Seo, Dong-Woo; Sohn, Chang Hwan; Kim, Won Young; Lim, Kyung-Taek; Donnino, Michael W.

doi:10.1259/bjr.20130273

Cited by 15 publications

(11 citation statements)

References 21 publications

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“…Patients with a CT RV/LV ratio >1.5 would be more likely to have impaired LV stroke volume, as a consequence of ventricular interdependence, and be farther along the pathophysiologic spiral towards shock [ 32 ]. Additionally, the presence of central clot on CT pulmonary angiogram was found to be a significant predictor of adverse PE outcomes in both the univariable and multivariable model, which is consistent with prior studies [ 28 , 33 ]. Currently used prediction scores do not include the presence of central pulmonary clot as a risk factor [ 7 , 17 ].…”

Section: Discussionsupporting

confidence: 89%

Rapid prediction of adverse outcomes for acute normotensive pulmonary embolism: derivation of the Calgary Acute Pulmonary Embolism score

et al. 2021

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BackgroundAcute pulmonary embolism (PE) has a wide spectrum of outcomes but the best method to risk stratify normotensive patients for adverse outcomes remains unclear.MethodsA multicenter retrospective cohort study of acute PE patients admitted from emergency departments in Calgary, Canada, between 2012–2017 was used to develop a refined acute PE risk score. The composite primary outcome of in-hospital PE-related death or hemodynamic decompensation. The model was internally validated using bootstrapping and the prognostic value of the derived risk score was compared to the Bova score.ResultsOf 2067 patients with normotensive acute PE, the primary outcome (hemodynamic decompensation or PE related death) occurred in 32 patients (1.5%). In sPESI high-risk patients (n=1498, 78%), a multivariable model used to predict the primary outcome retained computed tomography (CT) right-left ventricular diameter ratio ≥1.5, systolic blood pressure 90–100 mmHg, central pulmonary artery clot, & heart rate ≥100 BMP with a C-statistic of 0.89 (95%CI, 0.82–0.93). Three risk groups were derived using a weighted score (score, prevalence, primary outcome event rate): group 1 (0–3, 73.8%, 0.34%), group 2 (4–6, 17.6%, 5.8%), group 3 (7–9, 8.7%, 12.8%) with a C-statistic 0.85 (95%CI, 0.78–0.91). In comparison the prevalence (primary outcome) by Bova risk stages (n=1179) were: stage I, 49.8% (0.2%); stage II, 31.9% (2.7%); and stage III, 18.4% (7.8%) with a C-statistic 0.80 (95%CI, 0.74–0.86).ConclusionsA simple 4-variable risk score using clinical data immediately available after CT diagnosis of acute PE predicts in-hospital adverse outcomes. External validation of the CAPE score is required.

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Section: Discussionsupporting

confidence: 89%

Rapid prediction of adverse outcomes for acute normotensive pulmonary embolism: derivation of the Calgary Acute Pulmonary Embolism score

et al. 2021

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“…original finding in patients with cancer that emphasises the clinical-radiological dissociation previously described in isolated case reports [ 36,37 ]. Similarly to our results, many of the studies regarding saddle PE in the general population found no difference in overall mortality between saddle and non-saddle PE at 30 days [ 35,[39][40][41][42] ] although data from other heterogenous uncontrolled observational studies [ 43,44 ] suggest a greater risk of in-hospital mortality in patients with saddle PE. Taking all of this into account, the prognostic impact of saddle PE remains inconclusive.…”

Section: Accepted Manuscriptsupporting

confidence: 90%

Saddle Pulmonary Embolism in Patients with Cancer in the Era of Incidental Events: Clinical Findings and Outcomes in a Single Centre Cohort

Aramberri

Benegas

Sánchez

et al. 2022

TH Open

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Background There is scarce information regarding the prevalence and clinical impact of saddle pulmonary embolism (PE) in patients with cancer. Objectives To assess the prevalence, clinical findings, and short-term outcomes of patients with cancer-related saddle PE including acute symptomatic and unsuspected events. Patients/Methods Consecutive patients with cancer-related PE (2006 – 2014) were retrospectively reviewed by a chest radiologist to assess PE burden and signs of right ventricular (RV) overload. The clinical outcomes within 30 days were evaluated according to saddle vs. non-saddle PE. Results Thirty-six (12%) out of 289 patients with newly diagnosed cancer-related PE presented with saddle PE. Saddle PE was found in 21 cases (58%) with acute symptomatic PE and the remaining 15 cases (42%) were found as unsuspected findings. Patients with saddle PE had more frequently experienced a previous thrombotic event (31% vs. 13%; p=0.008) and it occurred more frequently as an acute symptomatic event (58% vs. 39%; p=0.025) compared to those with non-saddle PE. Signs of RV overload including RV/left ventricle ratio > 1 (22% vs. 4%; p<0.001) and interventricular septum displacement (53% vs. 20%; p<0.001) were also more common in patients with saddle PE compared to non-saddle PE. Overall, PE-related mortality, venous thromboembolism recurrence and major bleeding within 30 days were found to be similar according to saddle vs. non-saddle PE. Conclusions Saddle PE is not uncommon in patients with cancer-related PE including in those with unsuspected PE. Similar 30-day outcomes were found according to saddle vs. non-saddle PE in our cohort.

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“…[ 6 , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] ] Patients with massive PE or PEACE often present with proximal pulmonary artery thrombus, right heart strain (RHS), shock index ≥1 (heart-rate/blood pressure), and troponin elevation. [ 11 , 19 , 20 ] Many PE prognostic models include age, chronic cardiopulmonary disease, or cancer; however, other VTE risks could be associated with PEACE. [ [21] , [22] , [23] , [24] ] Identifying such risks may have diagnostic and prognostic implications for clinicians involved in the evaluation of acute PE and may aid in prognostic modeling.…”

Section: Introductionmentioning

confidence: 99%

Clinical factors associated with massive pulmonary embolism and PE-related adverse clinical events

Hariharan¹,

Giordano²,

Muzikansky³

et al. 2021

International Journal of Cardiology

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

Cited by 15 publications

References 21 publications

Rapid prediction of adverse outcomes for acute normotensive pulmonary embolism: derivation of the Calgary Acute Pulmonary Embolism score

Rapid prediction of adverse outcomes for acute normotensive pulmonary embolism: derivation of the Calgary Acute Pulmonary Embolism score

Saddle Pulmonary Embolism in Patients with Cancer in the Era of Incidental Events: Clinical Findings and Outcomes in a Single Centre Cohort

Clinical factors associated with massive pulmonary embolism and PE-related adverse clinical events

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