Contemporary Registry of Intermediate and High Risk Pulmonary Embolism Patients Presenting to a Large Tertiary Medical Center (PLATIS-PE)

Background: Patients with pulmonary embolism (PE) represent a challenging group of patients. While those with low risk PE can be managed mostly uneventfully, patients with intermediate and high risk PE mandate close monitoring and aggressive therapy, respectively, to prevent clinical deterioration. We present a consecutive cohort of intermediate and high risk patients treated in a large tertiary medical center.

Methods: Retrospective cohort of consecutive intermediate and high risk PE patients. PE was diagnosed based on CT findings. We evaluated patient demographics, risk factors, presenting symptoms, imaging studies, treatment, and in-hospital course.

Results: Overall 170 patients were evaluated. Of these, 144 were classified as intermediate risk PE and 26 as high risk PE. Mean patient age was 66.8 +- 16, 45% males. Forty-two percent had a history of recent immobilization, 29% a history of cancer, and 13% a prior history of venous thrombo-embolic event. The most common presenting sign was dyspnea (87%), followed by chest pain (45%), leg swelling (26%), and syncope. Upon imaging studies: 61% had right ventricular dysfunction, and 25% severe dysfunction. In the intermediate risk group, 15% (N=21) required escalation therapy as follows: 6 became hemodynamically unstable with 3 requiring inotropic therapy, 4 were further ventilated, 13 eventually received thrombolysis, and 1 underwent surgical pulmonary embolectomy. In the high risk group 42% underwent surgical pulmonary embolectomy and 39% received thrombolysis. Overall, in hospital mortality was 8%: 33% in the high risk group, and 6% in the intermediate risk group.

Conclusions: In contemporary practice, intermediate and high risk PE patients present a therapeutic challenge. These patients still suffer from a high mortality and complication rate mandating advanced close monitoring for detection of clinical deterioration in order to provide an adequate therapeutic response.