what’s important in PE? location, location, location

28 Feb

nice post from PulmCCM.org: “Forget “embolic burden” of pulmonary embolism: location is everything”

 

HIGHLIGHTS:

multicenter study out of Europe, 579 patients with acute symptomatic PE

Emboli were:

  • central in 60%,
  • lobar in 25%,
  • distal in 15%,
  • saddle in 13.5%,
  • subsegmental in 4.8%,

bilateral in 77%

Overall, 5.9% died and 4.5% had clinical deterioration (10.4% combined)

In hemodynamically stable patients

  • central PE was an independent predictor (HR 8.3, 1.0 to 67) of death or deterioration; 8.4% died or had clinical deterioration,
  • lobar PE was nearly so (HR 7.57, 0.95 to 60); 7.8% died or had clinical deterioration,
  • distal PE was associated with lower risk (HR 0.12, 0.01 to 0.97); 2.6% died or had clinical deterioration,

overall burden of PE was not associated with worse outcome

 

BOTTOM LINE:

central or lobar PE’s are bad, distal PE’s not so much.

total clot burden seems to matter less than location of the clot

 

References: post; picture

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