[Long-term outcome of acute massive pulmonary thromboembolism following thrombolysis].

Objective: To evaluate in-hospital course and long-term outcome of acute massive pulmonary thromboembolism after thrombolysis and to determine its prognostic factors.
Methods: A total of 260 patients was retrospectively reviewed and followed up for 3.9 - 8.4 years. Close attention was paid to the clinical events, including death, recurrent thromboembolic events, chronic thromboembolic pulmonary hypertension, bleeding complications attributed to anticoagulant therapy, and requirement of oxygen therapy at home. Kaplan-Meier event-free survival curves were generated.
Results: The in hospital mortality rate was 8.5%, in which 68.2% were due to pulmonary thromboembolism itself, and the follow-up mortality rate was 31.7%, in which 29.2% were due to recurrent embolism. Univariate analysis showed that six variables were associated with the occurrence of clinical events: (1) Prior thromboembolic diseases; (2) Duration of anticoagulant therapy less than 6 months; (3) Inferior vena cava filter placement; (4) Remaining right ventricular dysfunction/dilatation after thrombolysis detected by echocardiography; (5) Systolic pulmonary pressure > 50 mm Hg after thrombolysis by echocardiography; (6) Greater than 30% residual obstruction of pulmonary vasculature identified by lung ventilation/perfusion scintigraphy before hospital discharge. Multivariate analysis identified three independent risk factors for long-term mortality of acute massive pulmonary thromboembolism after thrombolysis: (1) Systolic pulmonary artery pressure > 50 mm Hg (RR: 3.78, 95% CI = 2.70 - 4.86); (2) Right ventricular dysfunction/dilatation (RR: 2.18, 95% CI = 1.48 - 2.88); (3) Greater than 30% obstruction of pulmonary vasculature (RR: 1.99, 95% CI = 1.25 - 2.70).
Conclusions: Doppler echocardiographic assessment after thrombolysis and ventilation/perfusion scintigraphy prior to hospital discharge are valuable to establish a new baseline condition, which is informative for risk stratification and prognostication of long-term outcome.