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Original Research: Pulmonary Vascular Disease |

Clinical Prognosis of Nonmassive Central and Noncentral Pulmonary Embolism: A Registry-Based Cohort Study

Bobby Gouin, MD; Marc Blondon, MD; David Jiménez, PhD; Carmen Fernández-Capitán, PhD; Henri Bounameaux, MD; Silvia Soler, MD; Rita Duce, MD; Joan Carles Sahuquillo, PhD; Nuria Ruiz-Giménez, PhD; Manuel Monreal, PhD
Author and Funding Information

Drs Gouin and Blondon contributed equally to the manuscript.

FUNDING/SUPPORT: Sanofi Spain supported this Registry with an unrestricted educational grant. Bayer Pharma AG also supported this Registry. Bayer Pharma AG’s support was limited to the part of RIETE outside Spain, which accounts for 22.92% of the total patients included in the RIETE Registry. B. G. was supported by a grant from Québec Foundation for progress of internal medicine.

aDivision of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland

bDivision of General Internal Medicine, Université de Sherbrooke, Sherbrooke, Canada (on leave)

cRespiratory Department, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain

dDepartment of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain

eDepartment of Internal Medicine, Hospital Universitario de La Princesa, Madrid, Spain

fDepartment of Internal Medicine, Hospital Olot i Comarcal de la Garrotxa, Gerona, Spain

gDepartment of Laboratory of Analysis, Ospedale Galliera, Genoa, Italy

hDepartment of Internal Medicine, Hospital Municipal de Badalona, Barcelona, Spain

iDepartment of Internal Medicine, Hospital Universitario Germans Trias i Pujol de Badalona, Barcelona, Spain, and Universidad Católica de Murcia, Murcia, Spain

CORRESPONDENCE TO: Bobby Gouin, MD, Division of Angiology and Haemostasis, Geneva University Hospitals, rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(4):829-837. doi:10.1016/j.chest.2016.10.056
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Background  Whether the localization of nonmassive pulmonary embolism (PE) is associated with the short-term and long-term prognosis of patients remains unknown. Our aim was to characterize associations of nonmassive PE localization with risks of recurrent VTE, major bleeding, and mortality during and after anticoagulation.

Methods  Among participants of the Registro Informatizado de la Enfermedad ThromboEmbòlica (RIETE) registry with incident symptomatic nonmassive PE diagnosed by CT scan, we compared risks of recurrent VTE, major bleeding, and mortality during and after anticoagulation between central PE (main pulmonary artery) and noncentral PE (more peripheral arteries) using Cox proportional hazard-adjusted models.

Results  Of the 6,674 participants, patients with central PE (40.5%) had age (mean 66 years), sex (46.9% male sex), and proportion of idiopathic (45.0%) and cancer-related (22.3%) PE that were similar to those of patients with noncentral PE. During anticoagulation (5,256.1 patient-years), the risk of recurrent VTE was similar between the two groups (2.5 vs 2.1 per 100 patient-years; adjusted hazard ratio [aHR], 1.32; 95% CI, 0.91-1.90), as were risks of major bleeding and mortality. After anticoagulation was discontinued (2,175.4 patient-years), participants with central PE had a borderline greater risk of recurrent VTE than did participants with noncentral PE (11.0 vs 8.0 per 100 patient-years; aHR, 1.34; 95% CI, 1.01-1.78) but not when restricted to participants after unprovoked PE (13.8 vs 11.9 per 100 patient-years; aHR, 1.15; 95% CI, 0.79-1.68; P = .48). Risks of major bleeding and mortality were similar.

Conclusions  In nonmassive PE, central localization of PE is associated with greater risk of recurrent VTE after anticoagulation cessation. However, the low magnitude of this association and the absence of association after unprovoked PE suggest that the clinical relevance of this finding is limited and that the duration of anticoagulation should not be tailored to PE localization after nonmassive unprovoked PE.

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