OBJECTIVES: To determine the clinical, historical, and instrumental findings associated with unfavorable short-term and long-term prognosis in elderly patients (>or=65) receiving thrombolytic therapy for pulmonary embolism (PE). DESIGN: Case-control retrospective study. SETTING: General medicine acute care ward. PARTICIPANTS: Sixty-seven elderly patients with PE complicated by hemodynamic instability (massive PE) admitted to the "Antonio Cardarelli" Hospital from January 1, 2002, to December 31, 2004, and evaluated during their hospital stay and 174.4+/-4.6 days after discharge. MEASUREMENTS: PE diagnosis was confirmed using spiral computed tomography angiography. Hemodynamic instability was defined as cardiogenic shock and systolic blood pressure less than 90 mmHg or a pressure drop of 40 mmHg or more for longer than 15 minutes not due to new-onset arrhythmia, hypovolemia, or sepsis. INTERVENTION: Weight-adapted unfractionated heparin and recombinant tissue plasminogen activator. RESULTS: Nine patients (13.4%) died during hospitalization. Higher troponin-I (cTn-I) serum levels at admission to the emergency department and the occurrence of thrombocytopenia after thrombolysis were significantly associated with in-hospital death. Nineteen of the 58 survivors (32.7%) died during follow-up. The risk factors for long-term death were historical findings of cancer and cardiovascular disease at hospital admission. CONCLUSION: Higher cTn-I serum levels in the acute phase and the occurrence of thrombocytopenia after thrombolysis were significantly associated with in-hospital mortality in elderly patients with massive PE. In the same setting, historical findings of cancer and cardiovascular disease are strong predictors of death in the long term.

Predictors of in-hospital and long-term clinical outcome in elderly patients with massive pulmonary embolism receiving thrombolytic therapy

RENDINA D.;DI MINNO, MATTEO;GALLOTTA, GIOVANNI;POSTIGLIONE, ALFREDO
2008

Abstract

OBJECTIVES: To determine the clinical, historical, and instrumental findings associated with unfavorable short-term and long-term prognosis in elderly patients (>or=65) receiving thrombolytic therapy for pulmonary embolism (PE). DESIGN: Case-control retrospective study. SETTING: General medicine acute care ward. PARTICIPANTS: Sixty-seven elderly patients with PE complicated by hemodynamic instability (massive PE) admitted to the "Antonio Cardarelli" Hospital from January 1, 2002, to December 31, 2004, and evaluated during their hospital stay and 174.4+/-4.6 days after discharge. MEASUREMENTS: PE diagnosis was confirmed using spiral computed tomography angiography. Hemodynamic instability was defined as cardiogenic shock and systolic blood pressure less than 90 mmHg or a pressure drop of 40 mmHg or more for longer than 15 minutes not due to new-onset arrhythmia, hypovolemia, or sepsis. INTERVENTION: Weight-adapted unfractionated heparin and recombinant tissue plasminogen activator. RESULTS: Nine patients (13.4%) died during hospitalization. Higher troponin-I (cTn-I) serum levels at admission to the emergency department and the occurrence of thrombocytopenia after thrombolysis were significantly associated with in-hospital death. Nineteen of the 58 survivors (32.7%) died during follow-up. The risk factors for long-term death were historical findings of cancer and cardiovascular disease at hospital admission. CONCLUSION: Higher cTn-I serum levels in the acute phase and the occurrence of thrombocytopenia after thrombolysis were significantly associated with in-hospital mortality in elderly patients with massive PE. In the same setting, historical findings of cancer and cardiovascular disease are strong predictors of death in the long term.
File in questo prodotto:
File Dimensione Formato  
357559.pdf

non disponibili

Tipologia: Documento in Post-print
Licenza: Accesso privato/ristretto
Dimensione 86.51 kB
Formato Adobe PDF
86.51 kB Adobe PDF   Visualizza/Apri   Richiedi una copia

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11588/357559
Citazioni
  • ???jsp.display-item.citation.pmc??? 0
  • Scopus 12
  • ???jsp.display-item.citation.isi??? 11
social impact