Comparison of Clinical and Imaging Characteristics and Outcomes between Provoked and Unprovoked Acute Pulmonary Embolism in Koreans

• Published in: Journal of Korean medical science Vol. 27; no. 11; pp. 1347 - 1353
• Main Authors: Uhm, Jae-Sun, Jung, Hae-Ok, Kim, Chan-Joon, Kim, Tae-Hoon, Youn, Ho-Joong, Baek, Sang Hong, Chung, Wook-Sung, Seung, Ki Bae
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Academy of Medical Sciences 01.11.2012; 대한의학회
• Subjects: Acute Disease; Adult; Aged; Aged, 80 and over; Asian Continental Ancestry Group; C-Reactive Protein - analysis; Creatinine - blood; Echocardiography; Female; Humans; Male; Middle Aged; Original; Prognosis; Pulmonary Embolism - diagnosis; Pulmonary Embolism - diagnostic imaging; Pulmonary Embolism - mortality; Recurrence; Renal Insufficiency - complications; Republic of Korea; Risk Factors; Survival Rate; Tomography, X-Ray Computed; 의학일반; Pulmonary Embolism; CT Obstruction Index; Unprovoked; Provoked
• ISSN: 1011-8934; 1598-6357; 1598-6357
• DOI: 10.3346/jkms.2012.27.11.1347

This study was performed to compare clinical and imaging parameters and prognosis of unprovoked pulmonary embolism (PE), provoked PE with reversible risk factors (provoked-rRF), and provoked PE with irreversible risk factors (provoked-iRF) in Koreans. Three hundred consecutive patients (mean age, 63.6 ± 15.0 yr; 42.8% male) diagnosed with acute PE were included. The patients were classified into 3 groups; unprovoked PE, provoked-rRF, and provoked-iRF; 43.7%, 14.7%, and 41.7%, respectively. We followed up the patients for 25.4 ± 33.7 months. Composite endpoint was all-cause mortality and recurrent PE. The provoked-iRF group had significantly higher all-cause mortality, mortality from PE and recurrent PE than the unprovoked and provoked-rRF groups (P < 0.001, P < 0.001, and P = 0.034, respectively). Prognostic factors of composite endpoint in the unprovoked group were high creatinine (> 1.2 mg/dL; P < 0.001; hazard ratio [HR], 4.735; 95% confidence interval [CI], 1.845-12.152), C-reactive protein (CRP; > 5 mg/L; P = 0.002; HR, 5.308; 95% CI, 1.824-15.447) and computed tomography (CT) obstruction index (P = 0.034; HR, 1.090; 95% CI, 1.006-1.181). In conclusion, provoked-iRF has a poorer prognosis than unprovoked PE and provoked-rRF. Renal insufficiency, high CRP, and CT obstruction index are poor prognostic factors in unprovoked PE.