<p><b>OBJECTIVE</b>To assess the in-
hospital clinical course and the long-term evolution of acute massive
pulmonary embolism after
thrombolytic therapy and to identify predictors of adverse clinical outcome.</p><p><b>
METHODS</b>A total of 260
patients hospitalized from January 1989 to October 1998 were retrospectively reviewed and followed up for 3.9 to 8.4 years. Baseline characteristics and variables pre- and post-thrombolysis were identified. Particular
attention was paid to the clinical events, including
death, recurrent
thromboembolism, chronic thromboembolic
pulmonary hypertension, and major
bleeding attributable to the use of
anticoagulants. Kaplan-Meier
event-free survival curves were generated. Univariate
analysis by means of the log-rank test was used to test each candidate variable for
association with clinical outcome.
Multivariate analysis with the Cox
proportional hazard model was used to determine independent predictors of the long-term outcome.</p><p><b>RESULTS</b>The
in-hospital mortality rate was 8.5%, with 68.2% due to
pulmonary embolism itself, and the follow-up mortality rate was 31.7%, with 29.2% due to recurrent
embolism. Factors associated with an adverse outcome in univariate
analysis were (1) prior thromboembolic
diseases; (2) duration of
anticoagulant therapy < 6 months; (3) inferior vena caval filter placement; (4) acute
right ventricular dysfunction/
dilation detected echocardiographically after thrombolysis; (5) Doppler recording of
pulmonary artery systolic pressure > 50 mmHg after thrombolysis; and (6) greater than 30% obstruction of pulmonary vasculature identified by
pulmonary ventilation/
perfusion scintigraphy before
hospital discharge.
Multivariate analysis identified three independent predictors of poor long-term outcome for
patients with acute massive
pulmonary embolism after thrombolysis; which were (1) Doppler recording of
pulmonary artery systolic pressure > 50 mmHg, with
relative risk of 3.78 and a 95%
confidence interval of 2.70 to 4.86; (2) echocardiographic evidence of
right ventricular dysfunction/
dilatation (
relative risk 2.18; 95%
confidence interval 1.48 to 2.88); and (3) greater than 30% obstruction of pulmonary vasculature documented by
lung scan (
relative risk 1.99; 95%
confidence interval 1.25 to 2.70).</p><p><b>CONCLUSION</b>The study showed that Doppler echocardiographic assessments after
thrombolytic therapy and
ventilation/
perfusion scintigraphy prior to
hospital discharge are valuable to establishment of new baseline characteristics, which is informative for
risk stratification and prognostication of the long-term outcome for
patients with acute massive
pulmonary embolism.</p>