- What is the prognostic utility of diagnosing SSPEs?
- What is the morbidity and mortality of SSPEs compared to more proximal PEs?
A recent study in 2013 Blood looked at these questions. 1
Cohorts for this study?
- 116/748 (15.5%) of patients had diagnosis of isolated SSPE
- 632/748 (84.5%) of patients had diagnosis of segmental or more proximal PE
- 2,980 patients had PE ruled out by clinical probability and a normal (D-Dimer or CTPA)
Cumulative risk for recurrent venous thromboembolism (VTE) at 3 months?
- SSPE = 3.6%
- Segmental and More Proximal PE = 2.5%
- PE Ruled-Out at Baseline = 1.1%
- Of note: There was a 99.9% follow-up rate of patients
- SSPE vs Segmental and More Proximal PE did not meet statistical significance
Percentage of patients with bleeding complications associated with treatment of PE?
- SSPE = 1.7%
- Segmental and More Proximal PE = 1.6%
- SSPE vs Segmental and More Proximal PE did not meet statistical significance
Cumulative mortality risk associated with each cohort?
- SSPE = 10.7%
- Segmental and More Proximal PE = 6.5%
- PE excluded = 5.4%
- SSPE vs Segmental and More Proximal PE did not meet statistical significance
What were the limitations of the study?
- Independent radiologists were not used to confirm the diagnosis of SSPE in majority of cases
- The definition of SSPE included both single and multiple SSPEs
- The absolute incidences of recurrent VTE, bleeding complications, and mortality were small
- An underpowered study to detect small changes in outcomes (i.e. SSPE vs Segmental and Proximal PE did not meet statistical significance)
Take Home Points
- SSPE has a similar rate of recurrent VTE at 3 months, bleeding complications from treatment, and mortality when compared to segmental and proximal PEs (no statistical significance among the 3 outcome measures).
- Should we question the conflicting data by Weiner et al stating: “ We have increased the incidence of PE diagnosis with CTPA ,but not changed the mortality risk”? 2
1.
den E, van E, Klok F, et al. Risk profile and clinical outcome of symptomatic subsegmental acute pulmonary embolism. Blood. 2013;122(7):1144-9; quiz 1329. [PubMed]
2.
Wiener R, Schwartz L, Woloshin S. Time trends in pulmonary embolism in the United States: evidence of overdiagnosis. Arch Intern Med. 2011;171(9):831-837. [PubMed]
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