Prognostic role of different temporal patterns of dyspnoea onset in patients with acute pulmonary embolism.

Aims: Dyspnoea is a well known symptom of acute pulmonary embolism (PE). We assess the prognostic role of different patterns of dyspnoea onset regarding in-hospital mortality, clinical deterioration and the composite of the outcomes in PE patients, according to their haemodynamic status at admission.

Methods: Patients from the prospective Italian Pulmonary Embolism Registry (IPER) were included in the study. At admission, patients were stratified, according to their haemodynamic status, as high- (haemodynamically unstable) and non-high-risk (haemodynamically stable) patients.

Results: Overall, 1623 consecutive patients (mean age 70.2 ± 15.2 years, 696 males), with confirmed acute PE, were evaluated for the features of dyspnoea. Among these, 1353 (83.3%) experienced dyspnoea at admission. No significant differences were observed regarding in-hospital mortality and the composite outcome of in-hospital mortality and clinical deterioration between patients with and without dyspnoea. However, in non-high-risk patients, clinical deterioration was more frequently observed when dyspnoea was present compared with absence of dyspnoea ( P  = 0.002). Multivariate Cox regression analyses showed that non-high-risk patients had an increased risk of clinical deterioration when experiencing dyspnoea within 24 h [hazard ratio (HR): 1.57, 95% confidence interval (CI): 1.49-1.65, P  < 0.0001] and between 25 h and 7 days before admission (HR: 1.66, 95% CI: 1.58-1.77, P  < 0.0001), independently of age, sex, right ventricular dysfunction, positive cardiac troponin and thrombolysis.

Conclusions: Non-high-risk PE patients experiencing dyspnoea within 7 days before hospitalization had a higher risk of clinical deterioration compared with those without and, therefore, they may require more aggressive management.