Predictors for Residual Pulmonary Vascular Obstruction after Unprovoked Pulmonary Embolism: Implications for Clinical Practice—The PADIS-PE Trial

Leela Raj; Philippe Robin; Raphael Le Mao; Emilie Presles; Cécile Tromeur; Olivier Sanchez; Gilles Pernod; Laurent Bertoletti; Patrick Jego; Florent Leven; Catherine A. Lemarié; Aurore Martin; Benjamin Planquette; Pierre-Yves Le Roux; Pierre-Yves Salaun; Michel Nonent; Philippe Girard; Karine Lacut; Solen Melac; Patrick Mismetti; Silvy Laporte; Guy Meyer; Christophe Leroyer; Francis Couturaud; for the PADIS-PE Investigators

doi:10.1055/s-0039-1692424

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2019; 119(09): 1489-1497
DOI: 10.1055/s-0039-1692424

Stroke, Systemic or Venous Thromboembolism

Georg Thieme Verlag KG Stuttgart · New York

Predictors for Residual Pulmonary Vascular Obstruction after Unprovoked Pulmonary Embolism: Implications for Clinical Practice—The PADIS-PE Trial

Leela Raj

¹Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, and EA 3878, CIC INSERM 1412, Brest, France

²Faculty of Heath Science, McMaster University, Hamilton, Ontario, Canada

,

Philippe Robin

³Service de Médecine Nucléaire and EA 3878, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, Brest, France

⁴F-CRIN INNOVTE, Saint Etienne, France

,

Raphael Le Mao

¹Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, and EA 3878, CIC INSERM 1412, Brest, France

⁴F-CRIN INNOVTE, Saint Etienne, France

,

Emilie Presles

⁴F-CRIN INNOVTE, Saint Etienne, France

⁵Unité de recherche clinique, Innovation et pharmacologie, Centre Hospitalo-Universitaire de Saint-Etienne, and INSERM U1059 SAINBIOSE, Université Jean Monnet, Saint-Etienne, France

,

Cécile Tromeur

¹Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, and EA 3878, CIC INSERM 1412, Brest, France

⁴F-CRIN INNOVTE, Saint Etienne, France

,

Olivier Sanchez

⁴F-CRIN INNOVTE, Saint Etienne, France

⁶Université Paris Descartes, Université Sorbonne Paris Cité, Service de Pneumologie et de soins intensifs, Hôpital Européen Georges Pompidou, AP-HP; Université Paris Descartes, Sorbonne Paris Cité, and INSERM UMR S 1140, Paris, France

,

Gilles Pernod

⁴F-CRIN INNOVTE, Saint Etienne, France

⁷Département de Médecine Vasculaire, Centre Hospitalo-Universitaire de Grenoble, Université de Grenoble 1, Grenoble, France

,

Laurent Bertoletti

⁴F-CRIN INNOVTE, Saint Etienne, France

⁸Service de Médecine Vasculaire et Thérapeutique, Unité de Pharmacologie Clinique, CIC1408, Centre Hospitalo-Universitaire de Saint-Etienne, and INSERM U1059 SAINBIOSE, Université Jean Monnet, Saint-Etienne, France

,

Patrick Jego

⁴F-CRIN INNOVTE, Saint Etienne, France

⁹Service de Médecine Interne, Centre Hospitalo-Universitaire de Rennes, Université de Rennes 1, Rennes, France

,

Florent Leven

¹⁰Service de Cardiologie and EA 3878, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, Brest, France

,

Catherine A. Lemarié

¹Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, and EA 3878, CIC INSERM 1412, Brest, France

⁴F-CRIN INNOVTE, Saint Etienne, France

,

Aurore Martin

¹¹Service d'Echo-doppler Vasculaire, and EA 3878, CIC INSERM 1412, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, Brest, France

,

Benjamin Planquette

⁴F-CRIN INNOVTE, Saint Etienne, France

⁶Université Paris Descartes, Université Sorbonne Paris Cité, Service de Pneumologie et de soins intensifs, Hôpital Européen Georges Pompidou, AP-HP; Université Paris Descartes, Sorbonne Paris Cité, and INSERM UMR S 1140, Paris, France

,

Pierre-Yves Le Roux

³Service de Médecine Nucléaire and EA 3878, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, Brest, France

⁴F-CRIN INNOVTE, Saint Etienne, France

,

Pierre-Yves Salaun

³Service de Médecine Nucléaire and EA 3878, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, Brest, France

⁴F-CRIN INNOVTE, Saint Etienne, France

,

Michel Nonent

¹²Service de Radiologie, and EA 3878, CIC INSERM 1412, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, Brest, France

,

Philippe Girard

⁴F-CRIN INNOVTE, Saint Etienne, France

¹³Département Thoracique, Institut Mutualiste Montsouris, Paris, France

,

Karine Lacut

¹Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, and EA 3878, CIC INSERM 1412, Brest, France

⁴F-CRIN INNOVTE, Saint Etienne, France

,

Solen Melac

¹Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, and EA 3878, CIC INSERM 1412, Brest, France

⁴F-CRIN INNOVTE, Saint Etienne, France

,

Patrick Mismetti

⁴F-CRIN INNOVTE, Saint Etienne, France

⁸Service de Médecine Vasculaire et Thérapeutique, Unité de Pharmacologie Clinique, CIC1408, Centre Hospitalo-Universitaire de Saint-Etienne, and INSERM U1059 SAINBIOSE, Université Jean Monnet, Saint-Etienne, France

,

Silvy Laporte

⁴F-CRIN INNOVTE, Saint Etienne, France

⁵Unité de recherche clinique, Innovation et pharmacologie, Centre Hospitalo-Universitaire de Saint-Etienne, and INSERM U1059 SAINBIOSE, Université Jean Monnet, Saint-Etienne, France

,

Guy Meyer

⁴F-CRIN INNOVTE, Saint Etienne, France

⁶Université Paris Descartes, Université Sorbonne Paris Cité, Service de Pneumologie et de soins intensifs, Hôpital Européen Georges Pompidou, AP-HP; Université Paris Descartes, Sorbonne Paris Cité, and INSERM UMR S 1140, Paris, France

,

Christophe Leroyer

¹Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, and EA 3878, CIC INSERM 1412, Brest, France

⁴F-CRIN INNOVTE, Saint Etienne, France

,

Francis Couturaud

¹Département de Médecine Interne et Pneumologie, Centre Hospitalo-Universitaire de Brest, Université de Bretagne Occidentale, and EA 3878, CIC INSERM 1412, Brest, France

⁴F-CRIN INNOVTE, Saint Etienne, France

,

for the PADIS-PE Investigators

› Institutsangaben

Abstract

Background We aimed to identify risk factors for residual pulmonary vascular obstruction after a first unprovoked pulmonary embolism (PE).

Methods Analyses were based on data from the double-blind randomized “PADIS-PE” trial that included 371 patients with a first unprovoked PE initially treated during 6 uninterrupted months; all patients underwent baseline ventilation–perfusion lung scanning at inclusion (i.e., after 6 months of anticoagulation). Each patient's pulmonary vascular obstruction indexes (PVOIs) at PE diagnosis and at inclusion were centrally assessed.

Results Among the 371 included patients, residual PVOI was available in 356 patients, and 150 (42.1%) patients had PVOI ≥ 5%. At multivariable analysis, age > 65 years (odds ratio [OR], 2.81, 95% confidence interval [CI], 1.58–5.00), PVOI ≥ 25% at PE diagnosis (OR, 3.53, 95% CI, 1.94–6.41), elevated factor VIII (OR, 3.89, 95% CI, 1.41–10.8), and chronic respiratory disease (OR, 2.18, 95% CI, 1.11–4.26) were independent predictors for residual PVOI ≥ 5%. Patients with ≥ 1 of these factors represented 94.5% (123 patients) of all patients with residual PVOI ≥ 5%.

Conclusion Six months after a first unprovoked PE, age > 65 years, PVOI ≥ 25% at PE diagnosis, elevated factor VIII, or chronic respiratory disease were found to be independent predictors for residual pulmonary vascular obstruction.

Clinical Trials Registration URL: http://www.controlled-trials.com. Unique identifier: NCT00740883.

Keywords

unprovoked pulmonary embolism - residual pulmonary vascular obstruction - recurrent venous thromboembolism - risk factors

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Referenzen

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