Management Strategies and Determinants of Outcome in Acute Major Pulmonary Embolism: Results of a Multicenter Registry
| Autor: | Stavros Konstantinides, Klaus Rauber, J Kienast, Manfred Olschewski, Wolfgang Kasper, Annette Geibel, Klaus D Grosser, Fritz Heinrich, Matthias Redecker, Stein Iversen |
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| Rok vydání: | 1997 |
| Předmět: |
Diagnostic Imaging
Male medicine.medical_specialty Circulatory collapse Ventricular Dysfunction Right medicine.medical_treatment Shock Cardiogenic Hemodynamics Germany Pulmonary angiography medicine Humans Thrombolytic Therapy Hospital Mortality Registries Intensive care medicine Survival analysis Aged Cardiac catheterization Vascular disease business.industry Respiratory disease Middle Aged medicine.disease Survival Analysis Pulmonary embolism Treatment Outcome Echocardiography Acute Disease Female Pulmonary Embolism business Cardiology and Cardiovascular Medicine |
| Zdroj: | Journal of the American College of Cardiology. 30(5):1165-1171 |
| ISSN: | 0735-1097 |
| DOI: | 10.1016/s0735-1097(97)00319-7 |
| Popis: | Objectives. The present study investigated current management strategies as well as the clinical course of acute major pulmonary embolism.Background. The clinical outcome of patients with acute pulmonary embolism who present with overt or impending right heart failure has not yet been adequately elucidated.Methods. The 204 participating centers enrolled a total of 1,001 consecutive patients. The inclusion criteria were based on the clinical findings at presentation and the results of electrocardiographic, echocardiographic, nuclear imaging and cardiac catheterization studies.Results. Echocardiography was the most frequently performed diagnostic procedure (74%). Lung scan or pulmonary angiography were performed in 79% of clinically stable patients but much less frequently in those with circulatory collapse at presentation (32%, p < 0.001). Thrombolytic agents were given to 478 patients (48%), often despite the presence of contraindications (193 [40%] of 478). The frequency of initial thrombolysis was significantly higher in clinically unstable than in normotensive patients (57% vs. 22%, p < 0.001). Overall in-hospital mortality rate ranged from 8.1% in the group of stable patients to 25% in those presenting with cardiogenic shock and to 65% in patients necessitating cardiopulmonary resuscitation. Major bleeding was reported in 92 patients (9.2%), but cerebral bleeding was uncommon (0.5%). Finally, recurrent pulmonary embolism occurred in 172 patients (17%).Conclusions. Current management strategies of acute major pulmonary embolism are largely dependent on the degree of hemodynamic instability at presentation. In the presence of severe hemodynamic compromise, physicians often rely on the findings of bedside echocardiography and proceed to thrombolytic treatment without seeking further diagnostic certainty in nuclear imaging or angiographic studies. |
| Databáze: | OpenAIRE |
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