Differences in risk factors between all-cause and pulmonary embolism-related death in acute pulmonary embolism: insights from the COMMAND VTE registry-2

Differences in risk factors between all-cause and pulmonary embolism-related death in acute pulmonary embolism: insights from the COMMAND VTE registry-2

Background: Accurate risk prediction of early mortality, particularly pulmonary embolism (PE)-related death, in patients with acute PE has become more important for selecting optimal management strategies. Objectives: To evaluate the cumulative 30-day incidence of and risk factors for all-cause and...

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Main Authors: Soichiro Kobayashi, Yoshito Ogihara, Yugo Yamashita, Takeshi Morimoto, Ryuki Chatani, Kazuhisa Kaneda, Yuji Nishimoto, Nobutaka Ikeda, Yohei Kobayashi, Satoshi Ikeda, Kitae Kim, Moriaki Inoko, Toru Takase, Shuhei Tsuji, Maki Oi, Takuma Takada, Kazunori Otsui, Jiro Sakamoto, Takeshi Inoue, Shunsuke Usami, Po-Min Chen, Kiyonori Togi, Norimichi Koitabashi, Seiichi Hiramori, Kosuke Doi, Hiroshi Mabuchi, Yoshiaki Tsuyuki, Koichiro Murata, Kensuke Takabayashi, Hisato Nakai, Daisuke Sueta, Wataru Shioyama, Tomohiro Dohke, Toru Sato, Ryusuke Nishikawa, Takeshi Kimura, Kaoru Dohi
Format: Article
Language:English
Published: Elsevier 2025-07-01
Series:Research and Practice in Thrombosis and Haemostasis
Subjects:
anticoagulants
factor Xa inhibitors
mortality
pulmonary embolism
risk assessment
Online Access:http://www.sciencedirect.com/science/article/pii/S2475037925002894
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Summary:Background: Accurate risk prediction of early mortality, particularly pulmonary embolism (PE)-related death, in patients with acute PE has become more important for selecting optimal management strategies. Objectives: To evaluate the cumulative 30-day incidence of and risk factors for all-cause and PE-related death within 30 days. Methods: In the COMMAND VTE Registry-2, which enrolled symptomatic patients with venous thromboembolism at 31 centers in Japan, we analyzed 2035 patients with acute PE. Results: The cumulative 30-day incidence of all-cause and PE-related death was 6.4% and 3.4%, respectively. Independent risk factors for all-cause and PE-related death were age >80 years (hazard ratio [HR], 2.43; 95% CI, 1.45-4.08; P < .001), hypoxemia (HR, 3.36; 95% CI, 1.07-10.5; P = .04), tachycardia (HR, 3.78; 95% CI, 2.20-6.50; P < .001), hypotension (HR, 5.43; 95% CI, 3.17-9.29; P < .001), an abnormal leukocyte count (HR, 1.78; 95% CI, 1.08-2.93; P = .02), and the absence of proximal deep vein thrombosis (HR, 2.58; 95% CI, 1.51-4.39; P < .001). Active cancer (HR, 2.59; 95% CI, 1.75-3.82; P < .001) and male sex (HR, 1.56; 95% CI, 1.07-2.28; P = .02) were independent risk factors for all-cause death, but not PE-related death. Chronic heart or lung disease (HR, 1.72; 95% CI, 1.02-2.90; P = .04) and right ventricular dysfunction (HR, 2.61; 95% CI, 1.02-6.70; P = .046) were independent risk factors for PE-related death, but not all-cause death. Conclusion: We identified several independent risk factors for PE-related death within 30 days, which differed from those of all-cause death. Risk factors specifically for PE-related death may be useful in decision-making for optimal treatment strategies for acute PE.
ISSN:2475-0379

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