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A3251 - Clinical Features, Management, and Outcome in Patients with Acute Pulmonary Embolism and a History of COPD
Author Block: G. Barmaimon1, J. Filopei2, E. Bondarsky2, B. Kim2, D. Steiger3; 1Pulmonary and Critical Care Medicine, Mount Sinai Beth Israel, New York, NY, United States, 2Mount Sinai Beth Israel, New York, NY, United States, 3Pulmonary/Critical Care, Mount Sinai Beth Israel, New York, NY, United States.
Rationale. Chronic obstructive pulmonary disease (COPD) affects approximately 33 million people in the USA, and is the fourth leading cause of mortality worldwide. COPD is a risk factor for venous thromboembolism (1). One year mortality from PE is greater in patients with COPD compared to COPD patients without PE (2). We describe the demographic, clinical presentation, imaging and cardiac bio-markers, therapeutic management and hospital and 30 day mortality for these patients. Method. Retrospective review of patients admitted with an acute PE, with underlying COPD, from a prospective registry of consecutive acute PE patients hospitalized at an urban teaching hospital. N=26 out of 407 patients in registry. Results. Mean age 66.6, with 55% male and mean length of stay 9.2 days. Most common complaints: dyspnea (69%) and pleuritic chest pain (38%) with mean duration prior to arrival of 4.6 days. All patients were hemodynamically stable. Wells score mean was 4.3. When performed, the age adjusted D-dimer was elevated in 11/12 (91%) patients. Cardiac bio-markers (troponin and BNP) were elevated in 35% and 53% respectively. Mean PESI class was 3. Central PE occurred in 14%, non-central 86%, and 34.6% were sole subsegmental while 23% of patients had a deep vein thrombosis. Half of PE cases were unprovoked and 19.2% considered incidental. Right ventricular (RV) hypokinesis on echo occurred in 20.8% patients, while 76% had elevated RV Systolic Pressure (mean 40.3 mmHg). Left ventricular systolic function was normal in 75%, and 70.8% had diastolic dysfunction. No patients received systemic thrombolytics, catheter directed thrombolysis, or open embolectomy. Total of 6/26 patients (23%) were readmitted within one month, 2 for gastrointestinal bleeding (7.6%), one each for pneumonia and CHF. One month follow up data was available for 19 patients (73%), one patient died (5.2%). Discussion. Patients with known COPD who presented with acute PE experiencing dyspnea and pleuritic chest pain, were likely considered intermediate pretest probability of PE, advanced PESI class, with a high prevalence of submassive intermediate risk PE with 20.5% demonstrating RV hypokinesis, however 35% PE were sole-subsegmental of unclear clinical significance. Conclusion. Acute PE patients with COPD present with non-specific symptoms, have a high rate of intermediate risk stratification and are at an increased risk of bleeding, readmission and mortality within one month of discharge. References. 1.Eur Heart J 2008,29:1276-2315 2. Chest 1996,110,(5):1212