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Acute Pulmonary Embolism Admitted to the ICU: A Retrospective Analysis (The APEAR Analysis) FREE TO VIEW

Mir Alikhan; Carter Co; Ketino Kobaidze, PhD; Leonard Glade; Samantha Shams; Tasnova Malek; Zohra Chaudhry; Mariam Japaridze; Kenneth Leeper
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Emory University, Atlanta, GA

Chest. 2014;146(4_MeetingAbstracts):515A. doi:10.1378/chest.1989668
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SESSION TITLE: Outcomes/Quality Control Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: To describe the risk factors, clinical presentation, mortality, and treatment outcomes in ICU patients admitted with acute pulmonary embolism (PE).

METHODS: Retrospective cohort analysis of adults admitted to the ICU with imaging-confirmed PE was conducted in two university teaching hospitals from January 2010 through December 2011. Clinical characteristics, management, and outcomes were collected.

RESULTS: 444 patients were admitted to the hospital with PE; 126 (28.4%) required ICU care. The median age was 58 years, 58.7% were female, and 57.1% were African American. Among the 126 patients, 92 (73%) had emboli confirmed by CT scan. 46 (50%) scans showed evidence of right heart strain and 70 (76.1%) had bilateral emboli. The average PESI score of 30-day survivors was 111 compared to 132 in non-survivors (p = 0.016). 100 (79.3%) patients met criteria for sub-massive or massive PE. 24 (19%) were classified as massive based on hemodynamic instability, and 76 (60.3%) had sub-massive based on RV dysfunction by echocardiography and/or elevated biomarkers without hypotension. Overall ICU mortality was 15.9%. PE-attributable mortality was 10.3%. 30-day mortality did not differ by severity of RV dysfunction. In sub-massive PE mortality was 13.2% compared to 25% in massive PE. 123 (97.6%) patients received anticoagulation, and 11.4% developed major bleeding complications. 56 (44.4%) IVC filters were inserted. 34 (44.7%) sub-massive PE patients and 14 (58.3%) massive PE patients received an IVC filter. Mortality in sub-massive PE with IVC filters was 14.7%, slightly higher than those who did not receive IVC filters (11.9%). However, in massive PE with IVC filters there was a trend towards decreased mortality compared to those with no IVC filter (14.3% vs. 40%; p = 0.19). PE-attributable mortality in those with IVC filters was 8.9%. Thrombolytics were used in 9.2% of sub-massive PE and 16.7% in massive PE.

CONCLUSIONS: Sub-massive and massive pulmonary embolic events require ICU admission and management. The PESI score predicted death in the highest risk class. Placement of IVC filters may improve survival in massive PE. The overall impact of IVC filters on PE-attributable mortality is not clear and warrants further study.

CLINICAL IMPLICATIONS: This study provides insight into the characteristics of PE patients requiring ICU admission. It also provides real-world data on the incidence, management, and outcomes of massive and sub-massive PE.

DISCLOSURE: The following authors have nothing to disclose: Mir Alikhan, Carter Co, Ketino Kobaidze, Leonard Glade, Samantha Shams, Tasnova Malek, Zohra Chaudhry, Mariam Japaridze, Kenneth Leeper

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