Prognostic factors in medically treated patients with chronic pulmonary embolism
Prognostic factors in medically treated patients with chronic pulmonary embolism
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DOI：
10.1378/chest.119.3.818
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发表时间：
2001-03-01
期刊：
影响因子：
9.6
通讯作者：
Wrabec, K
中科院分区：
文献类型：
--
作者：
Lewczuk, J;Piszko, P;Wrabec, K
目的：评估药物治疗的慢性肺栓塞（CPE）患者的危险因素，这些患者不适合进行明确的外科治疗。研究设计：共纳入53例血管造影证实的CPE患者。4例患者接受肺动脉内膜剥脱术，49例患者接受持续抗凝治疗，并随访了平均18.7个月（范围，6至72个月）。在未存活者中，12.5%发生远端CPE，87.5%发生近端CPE（p = 0.03）。存活者的Pao水平（平均值+/- SD）（59.3 +/- 11 mm Hg）高于非存活者（50.8 +/- 9 mm Hg; p = 0.02），平均肺动脉压（mPAP; 30. 3 +/- 15 mm Hg vs 51 +/- 21 mm Hg; p = 0.0004），红细胞压积值较低（40.0 +/- 6 vs 44.2 +/- 6; p = 0.03），运动耐力更好（4.8 +/- 3倍的静息O-2消耗[MET] vs 2.5 +/- 1 MET; p = 0.02）。同时存在COPD的患者的死亡率（62.5%）高于无COPD的患者（37.5%; p = 0.04）。考克斯分析中的独立风险因素如下：mPAP（p = 0.04）、运动耐量（p = 0.02）和COPD（p = 0.04）。Kaplan-Meier分析显示，死亡率较低的患者组METs> 2（p = 0.02），mPAP < 30 mm Hg（p = 0.04）。结论：药物治疗的CPE患者，尤其是合并肺动脉高压的CPE患者，预后不良。这些患者的预后因素是mPAP、COPD共存和严重运动不耐受。
Objective: To evaluate risk factors in medically treated patients with chronic pulmonary embolism (CPE) who are not suitable candidates for definitive surgical therapy.Study design: A total of 53 consecutive patients with angiographically confirmed CPE were involved. Four patients underwent pulmonary endarterectomy, and 49 patients received continuous anticoagulation therapy and were followed up over an average period of 18.7 months (range, 6 to 72 months).Results: Sixteen patients died during the follow-up period, mostly from progressive right ventricle failure. Among the nonsurvivors, 12.5% had distal CPE and 87.5% had proximal CPE (p = 0.03). The survivors had a higher (mean +/- SD) level of Pao, (59.3 +/- 11 mm Hg) than the nonsurvivors (50.8 +/- 9 mm Hg; p = 0.02), a lower mean pulmonary artery pressure (mPAP; 30..3 +/- 15 mm Hg vs 51 +/- 21 mm Hg; p = 0.0004), a lower hematocrit value (40.0 +/- 6 vs 44.2 +/- 6; p = 0.03), and better exercise tolerance (4.8 +/- 3 multiples of resting O-2 consumption [METs] vs 2.5 +/- 1 METs; p = 0.02) achieved during the maximal symptom-limited exercise. The patients with coexisting COPD had a higher mortality rate (62.5%) than those without COPD (37.5%; p = 0.04). Independent risk factors in the Cox analysis were as follows: mPAP (p = 0.04), exercise tolerance (p = 0.02), and COPD (p = 0.04). In the Kaplan-Meier analysis, the patient group with lower mortality achieved > 2 METs (p = 0.02) and had mPAP < 30 mm Hg (p = 0.04).Conclusion: The prognosis for the medically treated CPE patients, particularly those with pulmonary hypertension, was unfavorable. The prognostic factors for these patients were mPAP, coexistence of COPD, and severe exercise intolerance.