Risk stratification of acute pulmonary embolism and determining the effect on chronic cardiopulmonary complications: The REACH Study

Hannah Stevens, Wendy Fang, Warren Clements, Jason Bloom, James McFadyen, Huyen Tran

Research output: Contribution to journalArticleResearchpeer-review

Abstract

BackgroundPatients with acute pulmonary embolism (PE) are at risk of developing chronic complications including the post-PE syndrome with reduced cardiopulmonary function and chronic thromboembolism pulmonary hypertension (CTEPH). Risk stratification at PE diagnosis is an important tool in predicting early mortality, however its use in predicting chronic complications has not been evaluated. 
ObjectivesTo investigate the effect of initial risk stratification of intermediate risk and standard risk PE on the rate of development of chronic complications including right ventricular (RV) dysfunction, residual perfusion defects and CTEPH. MethodsCases of acute PE (n=1524) were identified using discharge International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) discharge diagnosis coding for PE. Evidence of RV dysfunction and systolic blood pressure <90mmHg were used to risk stratify into high, intermediate and standard risk PE. 
Results There were 508 patients included in the analysis. Intermediate risk PE was associated with higher rates of persistent RV dysfunction as well as residual perfusion defects on repeat imaging. The overall rate of CTEPH was low (0.6%) and there was no difference between the intermediate risk and standard risk PE groups.
ConclusionsThese findings demonstrate that acute intermediate risk PE is associated with higher rates of reduced cardiac function on follow-up imaging than standard risk PE. Moreover, CTEPH rates are low among all patients with acute PE.
Original languageEnglish
Pages (from-to)e45-e50
Number of pages6
JournalTH Open
Volume4
Issue number1
DOIs
Publication statusPublished - 14 Feb 2020

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