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(Chest. 2006;130:1817-1822.)
© 2006 American College of Chest Physicians

Clinical Syndromes and Clinical Outcome in Patients With Pulmonary Embolism*

Findings From the RIETE Registry

José Luís Lobo, MD; Vanesa Zorrilla, MD; Felipe Aizpuru, MD; Fernando Uresandi, MD; Ferrán Garcia-Bragado, MD; Francisco Conget, MD and Manuel Monreal, PhD

* From the Servicio de Neumología (Drs. Lobo and Zorilla) and Unidad de Investigación (Dr. Aizpuru), Hospital de Txagorritxu, Vitoria; Servicio de Neumología (Dr. Uresandi), Hospital de Cruces, Bilbao; Servicio de Medicina Interna (Dr. Garcia-Bragado), Hospital de Girona Dr. Josep Trueta, Girona; Servicio de Neumología (Dr. Conget), Hospital Clínico de Zaragoza, Zaragoza; and Servicio de Medicina Interna (Dr. Monreal), Hospital Universitari Germans Trias i Pujol, Badalona, Spain. {dagger} A complete list of RIETE investigators is given in the Appendix.

Correspondence to: Manuel Monreal, PhD, Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, 08916 Badalona (Barcelona), Spain; e-mail: mmonreal.germanstrias{at}gencat.net

Abstract

Introduction: The influence of the clinical syndromes of pulmonary embolism (PE) on clinical outcome has not been evaluated.

Patients and methods: The Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) is an ongoing registry of consecutive patients with acute venous thromboembolism. In this study, all enrolled patients with acute PE without preexisting cardiac or pulmonary disease were classified into three clinical syndromes: pulmonary infarction, isolated dyspnea, or circulatory collapse. Their clinical characteristics, laboratory findings, and 3-month outcomes were compared.

Results: As of January 2005, 4,145 patients with acute, symptomatic, objectively confirmed PE have been enrolled in RIETE. Of them, 3,391 patients (82%) had no chronic lung disease or heart failure: 1,709 patients (50%) had pulmonary infarction, 1,083 patients (32%) had isolated dyspnea, and 599 patients (18%) had circulatory collapse. Overall, 149 patients (4.4%) died during the first 15 days of therapy: 2.5% with pulmonary infarction, 6.2% with isolated dyspnea (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.7 to 3.8), and 6.5% with circulatory collapse (OR, 2.7; 95% CI, 1.7 to 4.2). From days 16 to 90, 31 patients had recurrent PE; 5 of 14 patients (36%) with pulmonary infarction died of their new PE, compared with 5 of 10 patients (50%) with isolated dyspnea, and all 7 patients (100%) with circulatory collapse.

Conclusions: PE patients with pulmonary infarction (50% of the whole series) had a significantly lower mortality rate both during initial therapy and after discharge.

Key Words: clinical syndromes • outcome • pulmonary embolism






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