Saddle Pulmonary Embolism is Not a Sign of High-risk Deterioration in Non-high-risk Patients: A Propensity Score-matched Study

Overview

Journal World J Emerg Med

Specialty Emergency Medicine

Date 2021 Sep 13

PMID 34512821

Citations 2

Authors

Dong Jia

Chao Ji

Min Zhao

Affiliations

Soon will be listed here.

Abstract

Background: There is controversy regarding whether saddle main pulmonary artery (MPA) embolism represents a high risk of deterioration in non-high-risk acute pulmonary embolism (PE) patients. This study aims to address this issue by conducting a propensity score matching (PSM) study.

Methods: A total of 727 non-high-risk acute PE patients were retrospectively evaluated. We evaluated the Bova score and risk stratification to examine the risk of deterioration. Deterioration defined as any adverse event within 30 days after admission. Computed tomographic pulmonary angiography was used to identify the embolism type. All patients were matched into four subgroups by PSM according to age, sex, Bova score, and risk stratification: (1) MPA and non-MPA embolism; (2) non-saddle MPA and non-MPA embolism; (3) saddle MPA and non-saddle MPA embolism; (4) saddle MPA and non-MPA embolism. Correlations were analyzed using Cox regression analysis, and deterioration risk was compared between subgroups using Kaplan-Meier analysis.

Results: Cox regression analysis revealed that MPA embolism was correlated with deterioration, regardless of whether saddle MPA embolism was included or excluded. Saddle MPA embolism was not correlated with deterioration, regardless of comparison with non-saddle MPA embolism or non-MPA embolism. Patients with MPA and non-saddle MPA embolism presented a high risk for deterioration (log-rank test=5.23 and 4.70, =0.022 and 0.030, respetively), while patients with saddle MPA embolism were not at a high risk of deterioration (log-rank test=1.20 and 3.17, =0.729 and 0.077, respetively).

Conclusions: Saddle MPA embolism is not indicative of a high risk of deterioration in non-high-risk acute PE patients.

Citing Articles

Increasing angiotensin-converting enzyme (ACE) 2/ACE axes ratio alleviates early pulmonary vascular remodeling in a porcine model of acute pulmonary embolism with cardiac arrest.

Xiao H, Zhao L, Yang J, Tong N, An L, Wang G World J Emerg Med. 2022; 13(3):208-214.

PMID: 35646211 PMC: 9108909. DOI: 10.5847/wjem.j.1920-8642.2022.052.

Comparison of two scores in predicting pulmonary embolism-related adverse events in intermediate-high-risk patients: a systematic review and meta-analysis.

Bova C, Vigna E, Gentile M, Pignataro F Intern Emerg Med. 2022; 17(5):1543-1546.

PMID: 35320490 DOI: 10.1007/s11739-022-02963-5.

References

Zuin M, Rigatelli G, Zonzin P, Casazza F, Roncon L . Saddle pulmonary embolism in hemodynamically stable patients: To lyse or not to lyse? An issue in no guidelines land. Eur J Intern Med. 2017; 46:e26-e28. DOI: 10.1016/j.ejim.2017.09.002. View

Beenen L, Bossuyt P, Stoker J, Middeldorp S . Prognostic value of cardiovascular parameters in computed tomography pulmonary angiography in patients with acute pulmonary embolism. Eur Respir J. 2018; 52(1). DOI: 10.1183/13993003.02611-2017. View

Santos A, Freitas P, Ferreira J, Oliveira A, Goncalves M, Faria D . Risk stratification in normotensive acute pulmonary embolism patients: focus on the intermediate-high risk subgroup. Eur Heart J Acute Cardiovasc Care. 2019; 9(4):279-285. DOI: 10.1177/2048872619846506. View

Liu M, Miao R, Guo X, Zhu L, Zhang H, Hou Q . Saddle Pulmonary Embolism: Laboratory and Computed Tomographic Pulmonary Angiographic Findings to Predict Short-term Mortality. Heart Lung Circ. 2016; 26(2):134-142. DOI: 10.1016/j.hlc.2016.02.019. View

Fernandez C, Bova C, Sanchez O, Prandoni P, Lankeit M, Konstantinides S . Validation of a Model for Identification of Patients at Intermediate to High Risk for Complications Associated With Acute Symptomatic Pulmonary Embolism. Chest. 2015; 148(1):211-218. DOI: 10.1378/chest.14-2551. View

Furlan A, Aghayev A, Chang C, Patil A, Jeon K, Park B . Short-term mortality in acute pulmonary embolism: clot burden and signs of right heart dysfunction at CT pulmonary angiography. Radiology. 2012; 265(1):283-93. PMC: 3447174. DOI: 10.1148/radiol.12110802. View

Konstantinides S, Meyer G, Becattini C, Bueno H, Geersing G, Harjola V . 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European.... Eur Respir J. 2019; 54(3). DOI: 10.1183/13993003.01647-2019. View

Gong Z, Cheng J, Gao P, Huang A, Sun Y, Zhou K . Clinical Characteristics and Prognostic Factors of Patients with Intrahepatic Cholangiocarcinoma with Fever: A Propensity Score Matching Analysis. Oncologist. 2019; 24(7):997-1007. PMC: 6656462. DOI: 10.1634/theoncologist.2018-0268. View

Peng Z, Wei M, Chen S, Lin M, Jiang C, Mei J . Combined transcatheter arterial chemoembolization and radiofrequency ablation versus hepatectomy for recurrent hepatocellular carcinoma after initial surgery: a propensity score matching study. Eur Radiol. 2018; 28(8):3522-3531. DOI: 10.1007/s00330-017-5166-4. View

10.

Liu W, Zou R, Wang C, Qiu J, Shen J, Liao Y . Microwave ablation resection for hepatocellular carcinoma within the Milan criteria: a propensity-score analysis. Ther Adv Med Oncol. 2019; 11:1758835919874652. PMC: 6740202. DOI: 10.1177/1758835919874652. View

11.

Hajizadeh R, Ghaffari S, Rajebi H, Kavandi H, Javanshir E, Fahimi G . Short-term mortality of patients with saddle pulmonary embolism: A single-center study. Turk Kardiyol Dern Ars. 2019; 47(4):273-280. DOI: 10.5543/tkda.2019.77292. View

12.

Sardi A, Gluskin J, Guttentag A, Kotler M, Braitman L, Lippmann M . Saddle pulmonary embolism: is it as bad as it looks? A community hospital experience. Crit Care Med. 2011; 39(11):2413-8. DOI: 10.1097/CCM.0b013e31822571b2. View

13.

Jia D, Li X, Zhang Q, Hou G, Zhou X, Kang J . A decision tree built with parameters obtained by computed tomographic pulmonary angiography is useful for predicting adverse outcomes in non-high-risk acute pulmonary embolism patients. Respir Res. 2019; 20(1):187. PMC: 6701135. DOI: 10.1186/s12931-019-1160-5. View

14.

Schievano S, Capelli C, Young C, Lurz P, Nordmeyer J, Owens C . Four-dimensional computed tomography: a method of assessing right ventricular outflow tract and pulmonary artery deformations throughout the cardiac cycle. Eur Radiol. 2010; 21(1):36-45. DOI: 10.1007/s00330-010-1913-5. View

15.

Zhou W, He J, Guo S, Walline J, Liu X, Tian L . Venous thromboembolism in the emergency department: A survey of current best practice awareness in physicians and nurses in China. World J Emerg Med. 2019; 10(1):5-13. PMC: 6264982. DOI: 10.5847/wjem.j.1920-8642.2019.01.001. View

16.

Alkinj B, Pannu B, Apala D, Kotecha A, Kashyap R, Iyer V . Saddle vs Nonsaddle Pulmonary Embolism: Clinical Presentation, Hemodynamics, Management, and Outcomes. Mayo Clin Proc. 2017; 92(10):1511-1518. DOI: 10.1016/j.mayocp.2017.07.014. View

17.

Rivera-Lebron B, Rali P, Tapson V . The PERT Concept: A Step-by-Step Approach to Managing Pulmonary Embolism. Chest. 2020; 159(1):347-355. DOI: 10.1016/j.chest.2020.07.065. View

18.

Qanadli S, El Hajjam M, Vieillard-Baron A, Joseph T, Mesurolle B, Oliva V . New CT index to quantify arterial obstruction in pulmonary embolism: comparison with angiographic index and echocardiography. AJR Am J Roentgenol. 2001; 176(6):1415-20. DOI: 10.2214/ajr.176.6.1761415. View

19.

Raslan I, Brown P, Westerhout C, Ezekowitz J, Hernandez A, Starling R . Characterization of hemodynamically stable acute heart failure patients requiring a critical care unit admission: Derivation, validation, and refinement of a risk score. Am Heart J. 2017; 188:127-135. DOI: 10.1016/j.ahj.2017.03.014. View

20.

Choi K, Cha S, Shin K, Lim J, Yoo S, Lee J . Central emboli rather than saddle emboli predict adverse outcomes in patients with acute pulmonary embolism. Thromb Res. 2014; 134(5):991-6. DOI: 10.1016/j.thromres.2014.08.027. View