Prognosis for Patients after Pulmonary Embolism and its Determining Factors (Results of 12-Month Follow-Up)

INTRODUCTION: Pulmonary embolism (PE) is a cardiovascular disease with high mortality: according to autopsy data, PE is the cause of death in every tenth deceased person. Despite a relatively long history of studying PE, the literature data on this problem are scattered, incomplete and often do not represent the Russian population.

AIM: To evaluate 12-month survival rate of patients after a past episode of PE and to establish predictors of fatal outcome.

MATERIALS AND METHODS: The work was carried out within the Russian SIRENA register. The study included 107 patients (age median and interquartile range 63 (52–74) years), who underwent inpatient treatment in Regional Clinical Cardiologic Dispensary of Ryazan (hospitalization from 01.05.2018 to 31.05.2019; inclusion period 13 months). In the period of hospitalization, the information was taken from the data of medical records and objective examinations, and after the discharge — through telephone control. Follow-up period from the moment of hospitalization was 12 months; response — 84.5%.

RESULTS: The 12-month survival rate of patients with PE was 77.1%; recurrence of venous thromboembolism developed in 6.5% of patients, bleeding — in 22.4% of patients. The only statistically significant predictor of the development of a fatal outcome after discharge from hospital was the presence of cancer, including that in history (relative risk (RR) 4.4; 95% confidence interval (CI) 1.4–14.5; p = 0.014). The leading predictors of death from the moment of hospitalization within 12 months were high risk based on the integral assessment of severity and of early death risk (RR 9.9; 95% CI 1.2–79.5; p = 0.031), age ≥ 65 years (RR 5.1; 95% CI 1.7–15.2; p = 0.003), hospitalization with other than PE primary diagnosis (RR 4.5; 95% CI 1.9–10.8; p = 0.001), impaired filtration function of kidneys (RR 4.3; 95% CI 1.7–11.1; p = 0.003). Besides, a statistically significant increase in the risk of death during this period was associated with history of atherosclerotic diseases, stroke, heart failure, oncology, hemodynamic instability in the acute period, the need for loop diuretics during hospitalization and the presence of S1Q3 syndrome.

CONCLUSION: The mortality rate of patients with PE in one of the regional vascular centers of Ryazan in 2018–2019 generally agrees with the data of the previous international studies. The leading predictors of fatal outcome within 12 months from the moment of hospitalization include a severe condition of a patient at the time of hospitalization, age ≥ 65 years, untimely diagnosis of PE and reduction of filtration function of kidneys.