A prospective study on cardiovascular events after acute pulmonary embolism

Aims To evaluate the incidence of cardiovascular events in the long-term clinical course of patients with a first episode of symptomatic, objectively confirmed pulmonary embolism. Methods and results Three hundred and sixty patients with a first episode of pulmonary embolism were included in a prospective study: 209 with idiopathic pulmonary embolism and 151 with pulmonary embolism associated with transient risk factors. The study outcomes were cardiovascular events (recurrent venous thrombo-embolism, acute myocardial infarction, stroke, sudden otherwise unexplained death), cardiovascular death, and death due to any cause. The median follow-up was 38 months. Sixty-four patients had at least one cardiovascular event (5.5% patient-year). Recurrent venous thrombo-embolism occurred in 45 patients (3.9% patient-year), acute myocardial infarction in 12 patients (1.0% patient-year), stroke in six patients (0.5% patient-year), and sudden otherwise unexplained death in four patients (0.3% patient-year). A cardiovascular event occurred in 47 patients with idiopathic pulmonary embolism (7.5% patient-year) and in 17 patients with pulmonary embolism associated with transient risk factors (3.1% patient-year) (RR 2.0; 95% CI 1.20–3.34; P =0.006). Twenty patients with idiopathic pulmonary embolism (3.2% patient-year) and two patients with pulmonary embolism associated with transient risk factors (0.4% patient-year) presented an arterial cardiovascular event (RR 7.2; 95% CI 1.71–30.45; P =0.001). Thirty-three patients died (9.2%). Cardiovascular mortality and cancer mortality accounted for 42.4 and 21.2% of overall mortality, respectively. Idiopathic pulmonary embolism was an independent predictor of cardiovascular events after adjusting for age. Conclusions Cardiovascular events are more common in patients with idiopathic pulmonary embolism than in patients with pulmonary embolism associated with transient risk factors. Cardiovascular events are the major cause of death in patients with idiopathic pulmonary embolism.

[1]  B. Giusti,et al.  Increased plasma levels of lipoprotein(a) and the risk of idiopathic and recurrent venous thromboembolism. , 2003, The American journal of medicine.

[2]  F. Schiele,et al.  In-hospital and long-term outcome after sub-massive and massive pulmonary embolism submitted to thrombolytic therapy. , 2003, European heart journal.

[3]  W. Ageno,et al.  Extended Oral Anticoagulant Therapy after a First Episode of Pulmonary Embolism , 2003, Annals of Internal Medicine.

[4]  M. Prins,et al.  An association between atherosclerosis and venous thrombosis. , 2003, The New England journal of medicine.

[5]  C. Jerjes-Sánchez,et al.  High Dose and Short-Term Streptokinase Infusion in Patients with Pulmonary Embolism: Prospective with Seven-Year Follow-Up Trial , 2001, Journal of Thrombosis and Thrombolysis.

[6]  W. Ageno,et al.  Three months versus one year of oral anticoagulant therapy for idiopathic deep venous thrombosis. Warfarin Optimal Duration Italian Trial Investigators. , 2001, The New England journal of medicine.

[7]  I. Durieu,et al.  Comparison of 3 and 6 Months of Oral Anticoagulant Therapy After a First Episode of Proximal Deep Vein Thrombosis or Pulmonary Embolism and Comparison of 6 and 12 Weeks of Therapy After Isolated Calf Deep Vein Thrombosis , 2001, Circulation.

[8]  M. Roncaglioni.  Low-dose aspirin and vitamin E in people at cardiovascular risk: a randomised trial in general Practice , 2001, The Lancet.

[9]  S. Schulman,et al.  The risk of ipsilateral versus contralateral recurrent deep vein thrombosis in the leg , 2000, Journal of internal medicine.

[10]  H. Eriksson,et al.  Recurrent venous thromboembolism after deep vein thrombosis: incidence and risk factors. , 2000, Archives of internal medicine.

[11]  L. Wilhelmsen,et al.  Smoking and abdominal obesity: risk factors for venous thromboembolism among middle-aged men: "the study of men born in 1913". , 1999, Archives of internal medicine.

[12]  M Gent,et al.  A comparison of three months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism. , 1999, The New England journal of medicine.

[13]  J. Manson,et al.  A prospective study of risk factors for pulmonary embolism in women. , 1997, JAMA.

[14]  Paolo Prandoni,et al.  The Long-Term Clinical Course of Acute Deep Venous Thrombosis , 1996, Annals of Internal Medicine.

[15]  K. Schulman,et al.  Cost-effectiveness analyses. , 1995, The New England journal of medicine.

[16]  P Prandoni,et al.  A Simple Ultrasound Approach for Detection of Recurrent Proximal‐Vein Thrombosis , 1993, Circulation.

[17]  G. Raskob,et al.  Hemorrhagic complications of anticoagulant treatment. , 1992, Chest.

[18]  A. Alavi,et al.  The clinical course of pulmonary embolism. , 1992, The New England journal of medicine.

[19]  N. Mantel.  Evaluation of survival data and two new rank order statistics arising in its consideration. , 1966, Cancer chemotherapy reports.

[20]  E. Kaplan,et al.  Nonparametric Estimation from Incomplete Observations , 1958 .

[21]  P. Prandoni,et al.  Three months vs. one year of oral anticoagulant therapy for idiopathic deep venous thrombosis , 2002 .

[22]  L. Melton,et al.  Predictors of recurrence after deep vein thrombosis and pulmonary embolism: a population-based cohort study. , 2000, Archives of internal medicine.