Document Detail


Novel management strategy for patients with suspected pulmonary embolism.
MedLine Citation:
PMID:  12581684     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: A simple management strategy is required for patients with acute pulmonary embolism which allows a rapid and reliable diagnosis in order to start timely and appropriate treatment. METHODS AND RESULTS: Two hundred and four consecutive patients with suspected pulmonary embolism were managed according to a standardized protocol based on the clinical pretest probability and the initial haemodynamic presentation (shock index=heart rate divided by systolic blood pressure). Patients with a high pretest probability and a positive shock index (> or =1) (n=21) underwent urgent transthoracic echocardiography. Based on the presence or absence of right ventricular dysfunction, reperfusion treatment was initiated immediately. Patients with a negative shock index (<1) (n=183) underwent diagnostic evaluation including pretest probability, D-dimer, and spiral computed tomography (CT) as first-line tests. Echocardiography was performed only when a central pulmonary embolism was found in the spiral CT(n=33). According to our strategy, 98 patients met the diagnostic criteria of pulmonary embolism: 75 patients (all shock index <1) were treated with heparin alone, 16 (seven had a shock index > or =1) with thrombolysis, four (all shock index > or =1) with catheter fragmentation, and three (all shock index > or =1) with surgical embolectomy. The all-cause mortality rate at 30 days was 5%, and at 6 months 11%. Right ventricular dysfunction on baseline echocardiography was not associated with a higher mortality rate at 6 months (logrank 2.4, P=0.12). CONCLUSIONS: The novel management strategy for patients with suspected pulmonary embolism resulted in a rapid diagnosis and treatment with a low 30-day mortality. In patients with pulmonary embolism and a positive shock index, time-consuming imaging tests can be avoided to reduce the risk of sudden death and not to delay reperfusion therapy.
Authors:
N Kucher; C M Luder; T Dörnhöfer; S Windecker; B Meier; O M Hess
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European heart journal     Volume:  24     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2003 Feb 
Date Detail:
Created Date:  2003-02-12     Completed Date:  2003-04-04     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  366-76     Citation Subset:  IM    
Affiliation:
Cardiology, Swiss Cardiovascular Center, University Hospital, CH-3010, Bern, Switzerland.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Administration, Oral
Aged
Anticoagulants / administration & dosage
Echocardiography
Female
Fibrin Fibrinogen Degradation Products / analysis
Humans
Male
Middle Aged
Pulmonary Embolism / diagnosis,  therapy*
Reperfusion / methods
Shock, Cardiogenic / diagnosis,  therapy
Survival Analysis
Tomography, Spiral Computed / methods
Vena Cava Filters
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Fibrin Fibrinogen Degradation Products; 0/fibrin fragment D

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