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

다국어 초록 (Multilingual Abstract)

This study was performed to compare clinical and imaging parameters and prognosis of unprovoked pulmonary embolism (PE), provoked PE with reversible risk factors (provokedrRF),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, provokediRF 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.

참고문헌 (Reference)

1 인광호, "급성 폐혈전색전증 전국 실태 조사 보고" 대한결핵및호흡기학회 54 (54): 5-14, 2003

2 Heit J, "Venous thromboembolism epidemiology: implications for prevention and management" 28 (28): 3-13, 2002

3 Prandoni P, "Venous thromboembolism and the risk of subsequent symptomatic atherosclerosis" 4 : 1891-1896, 2006

4 Fox EA, "The relationship between inflammation and venous thrombosis: a systematic review of clinical studies" 94 : 362-365, 2005

5 Van der Meer RW, "Right ventricular dysfunction and pulmonary obstruction index at helical CT: prediction of clinical outcome during 3-month follow-up in patients with acute pulmonary thromboembolism" 235 : 798-803, 2005

6 Quinones MA, "Recommendations for quantification of Doppler echocardiography: a report from the Doppler quantification task force of the nomenclature and standards committee of the American Society of Echocardiography" 15 : 167-184, 2002

7 Zoghbi WA, "Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography" 16 : 777-802, 2003

8 Lang RM, "Recommendations for chamber quantification: a report from the American Society of Echocardiography’s guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology" 18 : 1440-1463, 2005

9 Sanchez O, "Prognostic value of right ventricular dysfunction in patients with haemodynamically stable pulmonary embolism: a systematic review" 29 : 1569-1577, 2008

10 Sanchez O, "Prognostic factors for pulmonary embolism: the PREP study, a prospective multicenter cohort study" 181 : 168-173, 2010

11 Stein PD, "Prognosis based on creatinine kinase isoenzyme MB, cardiac troponin I, and right ventricular size in stable patients with acute pulmonary embolism" 107 : 774-777, 2011

12 Lopez JA, "Pathophysiology of venous thrombosis" 123 : S30-S34, 2009

13 Qanadli SD, "New CT index to quantify arterial obstruction in pulmonary embolism: comparison with angiographic index and echocardiography" 176 : 1415-1420, 2001

14 Jang MJ, "Metabolic syndrome is associated with venous thromboembolism in the Korean population" 29 : 311-315, 2009

15 Kucher N, "Massive pulmonary embolism" 113 : 577-582, 2006

16 Libby P, "Inflammation in atherosclerosis: from pathophysiology to practice" 54 : 2129-2138, 2009

17 Jang MJ, "Incidence of venous thromboembolism in Korea: from the health insurance review and assessment service database" 9 : 85-91, 2011

18 Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, "Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III)" 285 : 2486-2497, 2001

19 White RH, "Effects of race and ethnicity on the incidence of venous thromboembolism" 123 : S11-S17, 2009

20 Ozsu S, "Combined risk stratification with computerized tomography/echocardiography and biomarkers in patients with normotensive pulmonary embolism" 126 : 486-492, 2010

21 Wattanakit K, "Chronic kidney disease increases risk for venous thromboembolism" 19 : 135-140, 2008

22 Ageno W, "Cardiovascular risk factors and venous thromboembolism; a meta-analysis" 117 : 93-102, 2008

23 Lippi G, "C-reactive protein and venous thromboembolism: causal or casual association?" 48 : 1693-1701, 2010

24 AR, "C-reactive protein and venous thromboembolism: a prospective investigation in the ARIC cohort" 102 : 615-619, 2009

25 Zacho J, "C-reactive protein and risk of venous thromboembolism in the general population" 30 : 1672-1678, 2010

26 Prandoni P, "An association between atherosclerosis and venous thrombosis" 348 : 1435-1441, 2003