J Korean Med Sci.  2012 Nov;27(11):1347-1353. 10.3346/jkms.2012.27.11.1347.

Comparison of Clinical and Imaging Characteristics and Outcomes between Provoked and Unprovoked Acute Pulmonary Embolism in Koreans

• Uhm JS
• Jung HO
• Kim CJ
• Kim TH
• Youn HJ
• Baek SH
• Chung WS
• Seung KB

• KMID: 2157945
• DOI: http://doi.org/10.3346/jkms.2012.27.11.1347

Abstract

This study was performed to compare clinical and imaging parameters and prognosis of unprovoked pulmonary embolism (PE), provoked PE with reversible risk factors (provoked-rRF), and provoked PE with irreversible risk factors (provoked-iRF) in Koreans. Three hundred consecutive patients (mean age, 63.6 +/- 15.0 yr; 42.8% male) diagnosed with acute PE were included. The patients were classified into 3 groups; unprovoked PE, provoked-rRF, and provoked-iRF; 43.7%, 14.7%, and 41.7%, respectively. We followed up the patients for 25.4 +/- 33.7 months. Composite endpoint was all-cause mortality and recurrent PE. The provoked-iRF group had significantly higher all-cause mortality, mortality from PE and recurrent PE than the unprovoked and provoked-rRF groups (P < 0.001, P < 0.001, and P = 0.034, respectively). Prognostic factors of composite endpoint in the unprovoked group were high creatinine (> 1.2 mg/dL; P < 0.001; hazard ratio [HR], 4.735; 95% confidence interval [CI], 1.845-12.152), C-reactive protein (CRP; > 5 mg/L; P = 0.002; HR, 5.308; 95% CI, 1.824-15.447) and computed tomography (CT) obstruction index (P = 0.034; HR, 1.090; 95% CI, 1.006-1.181). In conclusion, provoked-iRF has a poorer prognosis than unprovoked PE and provoked-rRF. Renal insufficiency, high CRP, and CT obstruction index are poor prognostic factors in unprovoked PE.

Keyword

CT Obstruction Index; Provoked; Pulmonary Embolism; Unprovoked

MeSH Terms

Acute Disease
Adult
Aged
Aged, 80 and over
Asian Continental Ancestry Group
C-Reactive Protein/analysis
Creatinine/blood
Echocardiography
Female
Humans
Male
Middle Aged
Prognosis
Pulmonary Embolism/diagnosis/mortality/*radiography
Recurrence
Renal Insufficiency/complications
Republic of Korea
Risk Factors
Survival Rate
Tomography, X-Ray Computed
Creatinine
C-Reactive Protein

Figure

• 

  Fig. 1 Measurement of CT parameters. Measurement of diameters of the aorta and main pulmonary artery (A), and dimensions of the right and left ventricles (B). (C) An example of CT obstruction index; the right (solid arrow) and left (dashed arrow) pulmonary arteries are obstructed totally and partially, respectively. CT obstruction index is 75%.

• 

  Fig. 2 Cumulative mortality and recurrence rate in each group. (A) Cumulative all-cause mortality, (B) cumulative mortality from pulmonary embolism (PE), and (C) cumulative recurrence of PE by Kaplan-Meier method between unprovoked, provoked with reversible risk factors (provoked-rRF), and provoked with irreversible risk factors (provoked-iRF) groups.

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