AIMS: To systematically assess late outcomes of acute pulmonary embolism (PE) and to investigate the clinical implications of post-PE impairment (PPEI) fulfilling prospectively defined criteria. METHODS AND RESULTS: A prospective multicentre observational cohort study was conducted in 17 large-volume centres across Germany. Adult consecutive patients with confirmed acute symptomatic PE were followed with a standardized assessment plan and pre-defined visits at 3, 12, and 24 months. The co-primary outcomes were (i) diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH), and (ii) PPEI, a combination of persistent or worsening clinical, functional, biochemical, and imaging parameters during follow-up. A total of 1017 patients (45% women, median age 64 years) were included in the primary analysis. They were followed for a median duration of 732 days after PE diagnosis. The CTEPH was diagnosed in 16 (1.6%) patients, after a median of 129 days; the estimated 2-year cumulative incidence was 2.3% (1.2-4.4%). Overall, 880 patients were evaluable for PPEI; the 2-year cumulative incidence was 16.0% (95% confidence interval 12.8-20.8%). The PPEI helped to identify 15 of the 16 patients diagnosed with CTEPH during follow-up (hazard ratio for CTEPH vs. no CTEPH 393; 95% confidence interval 73-2119). Patients with PPEI had a higher risk of re-hospitalization and death as well as worse quality of life compared with those without PPEI. CONCLUSION: In this prospective study, the cumulative 2-year incidence of CTEPH was 2.3%, but PPEI diagnosed by standardized criteria was frequent. Our findings support systematic follow-up of patients after acute PE and may help to optimize guideline recommendations and algorithms for post-PE care.
- Valerio, L.
- Mavromanoli, A. C.
- Barco, S.
- Abele, C.
- Becker, D.
- Bruch, L.
- Ewert, R.
- Faehling, M.
- Fistera, D.
- Gerhardt, F.
- Ghofrani, H. A.
- Grgic, A.
- Grünig, E.
- Halank, M.
- Held, M.
- Hobohm, L.
- Hoeper, M. M.
- Klok, F. A.
- Lankeit, M.
- Leuchte, H. H.
- Martin, N.
- Mayer, E.
- Meyer, F. J.
- Neurohr, C.
- Opitz, C.
- Schmidt, K. H.
- Seyfarth, H. J.
- Wachter, R.
- Wilkens, H.
- Wild, P. S.
- Konstantinides, S. V.
- Rosenkranz, S.
Keywords
- Chronic thromboembolic pulmonary hypertension
- Follow-up
- Functional impairment
- Pulmonary embolism
