Pulmonary Embolism in Patients with Chronic Obstructive Pulmonary Disease or Congestive Heart Failure
Abstract
Background
The diagnosis of pulmonary embolism (PE) is often unreliable in patients with chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF).
Subjects and Methods
Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) is an ongoing registry of consecutive patients with acute venous thromboembolism. In this study, the clinical characteristics, laboratory findings, and clinical outcomes of all enrolled patients with acute PE, with or without underlying cardiopulmonary diseases, were compared and contrasted. In addition, the performance of 2 clinical models for the diagnosis of PE was retrospectively evaluated.
Results
As of January 2005, 4444 patients with symptomatic PE have been enrolled in RIETE. Of those, 632 patients (14%) had COPD and 422 (9.5%) had CHF. Significant differences were found in clinical presentation and 3-month outcomes among the 3 groups. With the Geneva model, there was a lower percentage of PE patients with COPD (relative risk [RR] 0.82; 95% confidence interval [CI], 0.66-1.02) or CHF (RR 0.73; 95% CI, 0.56-0.95) who fell into the low pretest probability category, compared with patients with neither. Besides, the percentage of patients with high probability of PE was similar among the 3 patient groups. The frequency of COPD (61%) and CHF (72%) patients with a high pretest probability for PE increased when using the Pisa score, but the percentage of COPD patients into the high probability group was lower (RR 0.60; 95% CI, 0.51-0.71).
Conclusions
Significant differences exist in PE patients with and without underlying cardiopulmonary diseases. The performance of the 2 clinical prediction models varied according to the presence or absence of underlying COPD or CHF.
aServicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
bServicio de Medicina Interna, Hospital San Pedro de Alcántara, Cáceres, Spain
cDivision of Respirology, University of Toronto, Canada
dServicio de Neumología, Hospital Universitario Ramón y Cajal, Madrid, Spain
eServicio de Medicina Interna, Hospital Sant Jaume, Gerona, Spain
fServicio de Medicina Interna, Complejo Hospitalario Xeral-Calde, Lugo, Spain
gServicio de Medicina Interna, Hospital SAS de Jerez, Cádiz, Spain.
Requests for reprints should be addressed Manuel Monreal, PhD, Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain.
Supported by Sanofi-Aventis, Paris, France with an unrestricted educational grant, and partially supported by Red Respira from the Instituto Carlos III, Madrid, Spain (RedRespira-ISCiii-RTIC-03/11).
A full list of RIETE investigators is given in the Appendix.
ABSTRACT
