MDCT-detected embolic burden and clinical outcome in patients with acute pulmonary embolism

Purpose: In patients with acute pulmonary embolism (PE) the correlation between the embolic burden at multidetector computed tomography (MDCT) and clinical outcome remains unclear. Methods: Consecutive patients with symptomatic acute PE diagnosed by MDCT were included in the study. The primary outcome was death or clinical deterioration at 30 days. Embolic burden was assessed by the obstruction index (OI) according to the scoring system of Qanadli and by the localization of emboli. Localization was categorised as: central (saddle or at least one main pulmonary artery), lobar or distal (segmental or subsegmental arteries). Cox regression analysis was used to assess predictors of death or clinical deterioration. Results: Overall, 579 patients were included in the study, 60 (10.4%) died or had clinical deterioration at 30 days. No correlation was found between OI or localization of emboli and clinical outcome in the overall population. In hemodynamically stable patients central localization of emboli (HR 8.3, 95% CI 1.0-67, p=0.047), age over 75 years and right ventricle dysfunction at echocardiography were independent predictors of death or clinical deterioration. (Figure presented) Conclusions: In hemodynamically stable patients with acute PE, central localization of emboli is associated with an increased risk for death or clinical deterioration.