Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER)
- PMID: 10227218
- DOI: 10.1016/s0140-6736(98)07534-5
Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER)
Abstract
Background: Pulmonary embolism (PE) remains poorly understood. Rates of clinical outcomes such as death and recurrence vary widely among trials. We therefore established the International Cooperative Pulmonary Embolism Registry (ICOPER), with the aim of identifying factors associated with death.
Methods: 2454 consecutive eligible patients with acute PE were registered from 52 hospitals in seven countries in Europe and North America. The primary outcome measure was all-cause mortality at 3 months. The prognostic effect of baseline factors on survival was assessed with multivariate analyses.
Findings: 2110 (86.0%) patients had PE proven by necropsy, high-probability lung scan, pulmonary angiography, or venous ultrasonography plus high clinical suspicion; ICOPER accepted without independent review diagnoses and interpretation of imaging provided by participating centres; 3-month follow-up was completed in 98.0% of patients. The overall crude mortality rate at 3 months was 17.4% (426 of 2454 deaths, including 52 patients lost to follow-up): 179 of 397 (45.1%) deaths were ascribed to PE and 70 of 397 (17.6%) to cancer, and no information on the cause of death was available for 29 patients. After exclusion of 61 patients in whom PE was first discovered at necropsy, the mortality rate at 3 months was 15.3% (365 of 2393 deaths). On multiple-regression modelling, age over 70 years (hazard ratio 1.6 [95% CI 1.1-2.3]), cancer (2.3 [1.5-3.5]), congestive heart failure (2.4 [1.5-3.7]), chronic obstructive pulmonary disease (1.8 [1.2-2.7]), systolic arterial hypotension (2.9 [1.7-5.0]), tachypnoea (2.0 [1.2-3.2]), and right-ventricular hypokinesis on echocardiography (2.0 [1.3-2.9]) were identified as significant prognostic factors.
Interpretation: PE remains an important clinical problem with a high mortality rate. Data from ICOPER provide rates and highlight adverse prognostic categories that will help in planning of future trials of high-risk PE patients.
Comment in
-
Prognosis in acute pulmonary embolism.Lancet. 1999 Apr 24;353(9162):1375-6. doi: 10.1016/S0140-6736(99)90053-3. Lancet. 1999. PMID: 10227212 No abstract available.
Similar articles
-
Clinical patterns and significance of non-compliance with guideline-recommended treatment of acute pulmonary embolism.Arch Cardiovasc Dis. 2020 Jan;113(1):31-39. doi: 10.1016/j.acvd.2019.09.009. Epub 2019 Nov 2. Arch Cardiovasc Dis. 2020. PMID: 31690519
-
Mortality risk assessment and the role of thrombolysis in pulmonary embolism.Crit Care Clin. 2011 Oct;27(4):953-67, vii-viii. doi: 10.1016/j.ccc.2011.09.008. Crit Care Clin. 2011. PMID: 22082522 Review.
-
Massive pulmonary embolism.Circulation. 2006 Jan 31;113(4):577-82. doi: 10.1161/CIRCULATIONAHA.105.592592. Epub 2006 Jan 23. Circulation. 2006. PMID: 16432055
-
Prognostic role of echocardiography among patients with acute pulmonary embolism and a systolic arterial pressure of 90 mm Hg or higher.Arch Intern Med. 2005 Aug 8-22;165(15):1777-81. doi: 10.1001/archinte.165.15.1777. Arch Intern Med. 2005. PMID: 16087827
-
Noninvasive diagnosis of pulmonary embolism.Haematologica. 1997 May-Jun;82(3):328-31. Haematologica. 1997. PMID: 9234581 Review.
Cited by
-
Prognostic value of pulmonary artery diameter/aorta diameter ratio in patients with acute pulmonary embolism.Herz. 2024 Jun 4. doi: 10.1007/s00059-024-05251-4. Online ahead of print. Herz. 2024. PMID: 38832941 English.
-
Perfusion index: could it be a new tool for early identification of pulmonary embolism severity?Intern Emerg Med. 2024 May 8. doi: 10.1007/s11739-024-03633-4. Online ahead of print. Intern Emerg Med. 2024. PMID: 38720051
-
Diagnostic performance of fluoroscopic video analysis for pulmonary embolism: a prospective observational study.Int J Cardiovasc Imaging. 2024 May 3. doi: 10.1007/s10554-024-03121-y. Online ahead of print. Int J Cardiovasc Imaging. 2024. PMID: 38700820
-
The Role of IVC Filters in the Management of Acute Pulmonary Embolism.J Clin Med. 2024 Mar 5;13(5):1494. doi: 10.3390/jcm13051494. J Clin Med. 2024. PMID: 38592401 Free PMC article. Review.
-
Pulmonary CT perfusion robustly measures cardiac output in the context of multilevel pulmonary occlusion: a porcine study.Eur Radiol Exp. 2024 Mar 22;8(1):51. doi: 10.1186/s41747-024-00431-7. Eur Radiol Exp. 2024. PMID: 38517595 Free PMC article.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical