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Computerized tomographic finding of saddle pulmonary embolism is associated with high mortality in cancer patients.
MedLine Citation:
PMID:  19220554     Owner:  NLM     Status:  In-Process    
BACKGROUND: Large pulmonary embolism (PE) is associated with high mortality in cancer patients. Several risk stratification methods have been used in PE setting. While computer-assisted tomography (CT) is now the preferred diagnostic modality for PE, its prognostic value is not well established.
METHODS: A retrospective study of patients discharged from our centre between 2000 and 2006 with a PE diagnosis identified 52 patients with thrombus in the main pulmonary artery or the right or left branch. Clinical, echocardiographic and CT data were reviewed; vital status was determined 1 month and 1 year after index event. Patients were divided into saddle (defined as main pulmonary artery thrombus) and non-saddle PE. Multivariate logistic regression was applied to predict vital status, with patient age and CT parameters as predictors.
RESULTS: Eighteen out of 52 patients were found to have a saddle PE. No significant difference was found between the group characteristics, although saddle PE patients were more likely to receive thrombolytic therapy (27.8% vs 2.9%, P = 0.02) and have an echocardiogram within 30 days of PE (61.1% vs 29.4%, P = 0.03). Overall mortality at 1 month was 9.6% with no difference between groups. At 1 year, mortality rates in saddle PE were significantly higher (83.3% vs 41.2%, P = 0.004). Presence of saddle PE was associated with an odds ratio of death within 1 year of 7.41 (95% confidence interval: 1.75-31.46, P = 0.007).
CONCLUSION: The relatively simple distinction of saddle versus non-saddle PE by CT findings may provide a straightforward method for risk stratification, and remains useful up to 1 year after the index event.
S W Yusuf; G Gladish; D J Lenihan; X Lei; J-B Durand; J Swafford; I N Daher
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2009-02-10
Journal Detail:
Title:  Internal medicine journal     Volume:  40     ISSN:  1445-5994     ISO Abbreviation:  Intern Med J     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-06-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101092952     Medline TA:  Intern Med J     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  293-9     Citation Subset:  IM    
Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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