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Use of biomarkers or echocardiography in pulmonary embolism: the Swiss Venous Thromboembolism Registry

Spirk, D. ; Willenberg, T. ; Aujesky, D. ; Husmann, M. ; Hayoz, D. ; Baldi, T. ; Brugger, A. ; Amann-Vesti, B. ; Baumgartner, I. ; Kucher, N.

In: QJM: An International Journal of Medicine, 2012, vol. 105, no. 12, p. 1163-1169

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    Titre
    • Use of biomarkers or echocardiography in pulmonary embolism: the Swiss Venous Thromboembolism Registry
    Auteur
    • Spirk, D.. From the Medical Department, Sanofi-Aventis (Suisse) SA, Meyrin 1217, Switzerland, Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College School of Medicine, Charing Cross Hospital, London W6 8RF, UK, Division of General Internal Medicine, University Hospital, Bern 3010, Clinic of Angiology, University Hospital, Zurich 8091, Department of Internal Medicine, Cantonal Hospital, Fribourg 1708, Department of Internal Medicine, University Hospital, Basel 4031 and Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital, Bern 3010, Switzerland
    • Willenberg, T.. From the Medical Department, Sanofi-Aventis (Suisse) SA, Meyrin 1217, Switzerland, Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College School of Medicine, Charing Cross Hospital, London W6 8RF, UK, Division of General Internal Medicine, University Hospital, Bern 3010, Clinic of Angiology, University Hospital, Zurich 8091, Department of Internal Medicine, Cantonal Hospital, Fribourg 1708, Department of Internal Medicine, University Hospital, Basel 4031 and Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital, Bern 3010, Switzerland
    • Aujesky, D.. From the Medical Department, Sanofi-Aventis (Suisse) SA, Meyrin 1217, Switzerland, Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College School of Medicine, Charing Cross Hospital, London W6 8RF, UK, Division of General Internal Medicine, University Hospital, Bern 3010, Clinic of Angiology, University Hospital, Zurich 8091, Department of Internal Medicine, Cantonal Hospital, Fribourg 1708, Department of Internal Medicine, University Hospital, Basel 4031 and Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital, Bern 3010, Switzerland
    • Husmann, M.. From the Medical Department, Sanofi-Aventis (Suisse) SA, Meyrin 1217, Switzerland, Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College School of Medicine, Charing Cross Hospital, London W6 8RF, UK, Division of General Internal Medicine, University Hospital, Bern 3010, Clinic of Angiology, University Hospital, Zurich 8091, Department of Internal Medicine, Cantonal Hospital, Fribourg 1708, Department of Internal Medicine, University Hospital, Basel 4031 and Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital, Bern 3010, Switzerland
    • Hayoz, D.. From the Medical Department, Sanofi-Aventis (Suisse) SA, Meyrin 1217, Switzerland, Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College School of Medicine, Charing Cross Hospital, London W6 8RF, UK, Division of General Internal Medicine, University Hospital, Bern 3010, Clinic of Angiology, University Hospital, Zurich 8091, Department of Internal Medicine, Cantonal Hospital, Fribourg 1708, Department of Internal Medicine, University Hospital, Basel 4031 and Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital, Bern 3010, Switzerland
    • Baldi, T.. From the Medical Department, Sanofi-Aventis (Suisse) SA, Meyrin 1217, Switzerland, Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College School of Medicine, Charing Cross Hospital, London W6 8RF, UK, Division of General Internal Medicine, University Hospital, Bern 3010, Clinic of Angiology, University Hospital, Zurich 8091, Department of Internal Medicine, Cantonal Hospital, Fribourg 1708, Department of Internal Medicine, University Hospital, Basel 4031 and Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital, Bern 3010, Switzerland
    • Brugger, A.. From the Medical Department, Sanofi-Aventis (Suisse) SA, Meyrin 1217, Switzerland, Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College School of Medicine, Charing Cross Hospital, London W6 8RF, UK, Division of General Internal Medicine, University Hospital, Bern 3010, Clinic of Angiology, University Hospital, Zurich 8091, Department of Internal Medicine, Cantonal Hospital, Fribourg 1708, Department of Internal Medicine, University Hospital, Basel 4031 and Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital, Bern 3010, Switzerland
    • Amann-Vesti, B.. From the Medical Department, Sanofi-Aventis (Suisse) SA, Meyrin 1217, Switzerland, Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College School of Medicine, Charing Cross Hospital, London W6 8RF, UK, Division of General Internal Medicine, University Hospital, Bern 3010, Clinic of Angiology, University Hospital, Zurich 8091, Department of Internal Medicine, Cantonal Hospital, Fribourg 1708, Department of Internal Medicine, University Hospital, Basel 4031 and Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital, Bern 3010, Switzerland
    • Baumgartner, I.. From the Medical Department, Sanofi-Aventis (Suisse) SA, Meyrin 1217, Switzerland, Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College School of Medicine, Charing Cross Hospital, London W6 8RF, UK, Division of General Internal Medicine, University Hospital, Bern 3010, Clinic of Angiology, University Hospital, Zurich 8091, Department of Internal Medicine, Cantonal Hospital, Fribourg 1708, Department of Internal Medicine, University Hospital, Basel 4031 and Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital, Bern 3010, Switzerland
    • Kucher, N.. From the Medical Department, Sanofi-Aventis (Suisse) SA, Meyrin 1217, Switzerland, Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College School of Medicine, Charing Cross Hospital, London W6 8RF, UK, Division of General Internal Medicine, University Hospital, Bern 3010, Clinic of Angiology, University Hospital, Zurich 8091, Department of Internal Medicine, Cantonal Hospital, Fribourg 1708, Department of Internal Medicine, University Hospital, Basel 4031 and Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital, Bern 3010, Switzerland
    Type de document
    • Postprint
    Langue
    • Inglese
    Publié dans
    • QJM: An International Journal of Medicine, 2012, vol. 105, no. 12, p. 1163-1169. Oxford University Press
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:290957
    Summary
    Background: Cardiac biomarkers and echocardiography for assessing right ventricular function are recommended to risk stratify patients with acute non-massive pulmonary embolism (PE), but it remains unclear if these tests are performed systematically in daily practice. Design and methods: Overall, 587 patients with acute non-massive PE from 18 hospitals were enrolled in the Swiss Venous Thromboembolism Registry (SWIVTER): 178 (30%) neither had a biomarker test nor an echocardiographic evaluation, 196 (34%) had a biomarker test only, 47 (8%) had an echocardiogram only and 166 (28%) had both tests. Results: Among the 409 (70%) patients with biomarkers or echocardiography, 210 (51%) had at least one positive test and 67 (16%) had positive biomarkers and right ventricular dysfunction. The ICU admission rates were 5.1% without vs. 5.6% with testing (P = 0.78), and thrombolysis or embolectomy were performed in 2.8% vs. 4.9%, respectively (P = 0.25). In multivariate analysis, syncope [odds ratio (OR): 3.49, 95% confidence interval (CI): 1.20-10.15; P = 0.022], tachycardia (OR: 2.31, 95% CI: 1.37-3.91; P = 0.002) and increasing age (OR: 1.02; 95% CI: 1.01-1.04; P < 0.001) were associated with testing of cardiac risk; outpatient status at the time of PE diagnosis (OR: 2.24, 95% CI: 1.49-3.36; P < 0.001), cancer (OR: 1.81, 95% CI: 1.17-2.79; P = 0.008) and provoked PE (OR: 1.58, 95% CI: 1.05-2.40; P = 0.029) were associated with its absence. Conclusions: Although elderly patients and those with clinically severe PE were more likely to receive a biomarker test or an echocardiogram, these tools were used in only two-thirds of the patients with acute non-massive PE and rarely in combination