Management strategies and determinants of outcome in acute major pulmonary embolism: Results of a multicenter registry
Management strategies and determinants of outcome in acute major pulmonary embolism: Results of a multicenter registry
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DOI：
10.1016/s0735-1097(97)00319-7
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发表时间：
1997-11-01
影响因子：
24
通讯作者：
Kienast, J
中科院分区：
文献类型：
--
作者：
Kasper, W;Konstantinides, S;Kienast, J
目标.本研究调查了目前的管理策略以及急性严重肺栓塞的临床过程。急性肺栓塞患者出现明显或即将出现右心衰竭的临床结局尚未得到充分阐明。204家参与中心共入组了1，001例连续患者。入选标准基于临床表现和心电图、超声心动图、核成像和心导管检查结果。超声心动图是最常进行的诊断程序（74%）。79%临床稳定的患者进行了肺扫描或肺血管造影，但在出现循环衰竭的患者中很少进行（32%，p < 0.001）。478例患者（48%）接受了溶栓药物治疗，通常是在存在禁忌症的情况下（193/478 [40%]）。临床不稳定患者的初始溶栓频率显著高于血压正常患者（57% vs.22%，p < 0.001）。总体住院死亡率范围从稳定患者组的8.1%到心源性休克患者组的25%，以及需要心肺复苏的患者组的65%。92例患者（9.2%）报告了大出血，但脑出血不常见（0.5%）。最后，172例患者（17%）发生了复发性肺栓塞。目前急性肺栓塞的治疗策略在很大程度上取决于血流动力学不稳定的程度。在存在严重血流动力学损害的情况下，医生通常依赖于床旁超声心动图的结果并进行溶栓治疗，而不寻求核成像或血管造影研究的进一步诊断确定性。(C)1997年，美国心脏病学会。
Objectives. The present study investigated current management strategies as well as the clinical course of acute major pulmonary embolism.Background. The clinical outcome of patients with acute pulmonary embolism who present with overt or impending right heart failure has not yet been adequately elucidated.Methods. The 204 participating centers enrolled a total of 1,001 consecutive patients. The inclusion criteria were based on the clinical findings at presentation and the results of electrocardiographic, echocardiographic, nuclear imaging and cardiac catheterization studies.Results. Echocardiography was the most frequently performed diagnostic procedure (74%). Lung scan or pulmonary angiography were performed in 79% of clinically stable patients but much less frequently in those with circulatory collapse at presentation (32%, p < 0.001). Thrombolytic agents were given to 478 patients (48%), often despite the presence of contraindications (193 [40%] of 478). The frequency of initial thrombolysis was significantly higher in clinically unstable than in normotensive patients (57% vs. 22%, p < 0.001). Overall in-hospital mortality rate ranged from 8.1% in the group of stable patients to 25% in those presenting with cardiogenic shock and to 65% in patients necessitating cardiopulmonary resuscitation. Major bleeding was reported in 92 patients (9.2%), but cerebral bleeding was uncommon (0.5%). Finally, recurrent pulmonary embolism occurred in 172 patients (17%).Conclusions. Current management strategies of acute major pulmonary embolism are largely dependent on the degree of hemodynamic instability at presentation. In the presence of severe hemodynamic compromise, physicians often rely on the findings of bedside echocardiography and proceed to thrombolytic treatment without seeking further diagnostic certainty in nuclear imaging or angiographic studies. (C) 1997 by the American College of Cardiology.