The timing of death in acute pulmonary embolism patients regarding the mortality risk stratification at admission to the hospital
Slobodan Obradovic,
Boris Dzudovic,
Piotr Pruszczyk,
Ivica Djuric,
Bojana Subotic,
Jovan Matijasevic,
Marija Benic,
Sonja Salinger,
Ljiljana Kos,
Tamara Kovacevic-Preradovic,
Irena Mitevska,
Srdjan Kafedzic,
Aleksandar Neskovic,
Bjanka Bozovic,
Nebojsa Bulatovic,
Vladimir Miloradovic
Affiliations
Slobodan Obradovic
Clinic of Cardiology, Military Medical Academy of Belgrade, Serbia; School of Medicine, University of Defense, Belgrade, Serbia
Boris Dzudovic
School of Medicine, University of Defense, Belgrade, Serbia; Clinic of Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia; Corresponding author. Clinic for Emergency Internal Medicine, Military Medical Academy, Belgrade, Serbia.
Piotr Pruszczyk
Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland
Ivica Djuric
Clinic of Cardiology, Military Medical Academy of Belgrade, Serbia
Bojana Subotic
Clinic of Cardiology, Military Medical Academy of Belgrade, Serbia
Jovan Matijasevic
Institute of Pulmonary Diseases Vojvodina, Novi Sad, Serbia; School of Medicine, University of Novi Sad, Serbia
Marija Benic
Institute of Pulmonary Diseases Vojvodina, Novi Sad, Serbia
Sonja Salinger
Clinic of Cardiology, Clinical Center Nis, Serbia; School of Medicine, University of Nis, Serbia
Ljiljana Kos
Clinic of Cardiology, Clinical Center Banja Luka, Bosnia and Herzegovina
Tamara Kovacevic-Preradovic
Clinic of Cardiology, Clinical Center Banja Luka, Bosnia and Herzegovina; School of Medicine, University of Banja Luka, Bosnia and Herzegovina
Irena Mitevska
University Cardiology Clinic, Intensive Care Unit, Skopje, Macedonia
Srdjan Kafedzic
Clinic of Cardiology, University Clinical Center Zemun, Serbia
Aleksandar Neskovic
Clinic of Cardiology, University Clinical Center Zemun, Serbia; School of Medicine, University of Belgrade, Serbia
Bjanka Bozovic
Clinic of Cardiology, Clinical Center Podgorica, Montenegro; School of Medicine, University of Podgorica, Montenegro
Nebojsa Bulatovic
Clinic of Cardiology, Clinical Center Podgorica, Montenegro; School of Medicine, University of Podgorica, Montenegro
Vladimir Miloradovic
Clinic of Cardiology, Clinical Center Kragujevac, Serbia; School of Medicine, University of Kragujevac, Serbia
Background: The management of patients with acute pulmonary embolism (aPE) depends on the severity of aPE. The timing of death in various aPE risk subgroups is only partially known. Methods: 1618 patients with an objectively established aPE diagnosis with computed tomography pulmonary angiography enrolled in the regional PE registry were included in the study. According to ESC criteria, patients were stratified at admission to the hospital in four risk strata. The timing of PE-related and non-PE-related deaths was analyzed regarding mortality risk. Results: PE-related, and non-PE-related hospital death rates were 1.1 % and 1.5 % in low, 1.1 % and 4.8 % in intermediate-low, 8.1 % and 5.9 % in intermediate-high, and 27.7 % and 6.9 % in high-risk groups, respectively. The median time of PE-related and non-PE-related death across the PE mortality risk were: 4 (1.7–7.5) and 7.0 (4–14.7) days in low, 1.5 (1.0–9.5) and 11.5 (2.0–21.0) days in intermediate-low, 4.0 (2.0–9.0) and 9.0 (5.7–18.2) days in intermediate-high, 2.0 (1.0–4.75) and 7.0 (3.0–21.2) days in high-risk subgroups. 48.2 % and 17.1 % of patients who died in the high and intermediate-high risks died during the first hospital day. After the 6th hospitalization day, PE-related deaths were recorded in 43.9 % of deaths from intermediate-high and 17.9 % from high-risk subgroups. Conclusion: PE-related mortality is prominent on the first hospitalization day in high and intermediate-high-risk PE. A substantial proportion of intermediate-high and high-risk patient's PE deaths occurred after the first 6 days of hospitalization.
