Differences in risk factors between all-cause and pulmonary embolism-related death in acute pulmonary embolism: insights from the COMMAND VTE registry-2

Abstract

Background

Accurate risk prediction of early mortality, particularly pulmonary embolism (PE)-related death, in patients with acute PE has become more important for selecting optimal management strategies.

Objectives

To evaluate the cumulative 30-day incidence of and risk factors for all-cause and PE-related death within 30 days.

Methods

In the COMMAND VTE Registry-2, which enrolled symptomatic patients with venous thromboembolism at 31 centers in Japan, we analyzed 2035 patients with acute PE.

Results

The cumulative 30-day incidence of all-cause and PE-related death was 6.4% and 3.4%, respectively. Independent risk factors for all-cause and PE-related death were age >80 years (hazard ratio [HR], 2.43; 95% CI, 1.45-4.08; P < .001), hypoxemia (HR, 3.36; 95% CI, 1.07-10.5; P = .04), tachycardia (HR, 3.78; 95% CI, 2.20-6.50; P < .001), hypotension (HR, 5.43; 95% CI, 3.17-9.29; P < .001), an abnormal leukocyte count (HR, 1.78; 95% CI, 1.08-2.93; P = .02), and the absence of proximal deep vein thrombosis (HR, 2.58; 95% CI, 1.51-4.39; P < .001). Active cancer (HR, 2.59; 95% CI, 1.75-3.82; P < .001) and male sex (HR, 1.56; 95% CI, 1.07-2.28; P = .02) were independent risk factors for all-cause death, but not PE-related death. Chronic heart or lung disease (HR, 1.72; 95% CI, 1.02-2.90; P = .04) and right ventricular dysfunction (HR, 2.61; 95% CI, 1.02-6.70; P = .046) were independent risk factors for PE-related death, but not all-cause death.

Conclusion

We identified several independent risk factors for PE-related death within 30 days, which differed from those of all-cause death. Risk factors specifically for PE-related death may be useful in decision-making for optimal treatment strategies for acute PE.