Frequency and predictors for chronic thromboembolic pulmonary hypertension after a first unprovoked pulmonary embolism: Results from PADIS studies.
clinical studies
incidence
pulmonary embolism
pulmonary hypertension
risk factors
Journal
Journal of thrombosis and haemostasis : JTH
ISSN: 1538-7836
Titre abrégé: J Thromb Haemost
Pays: England
ID NLM: 101170508
Informations de publication
Date de publication:
12 2022
12 2022
Historique:
revised:
10
07
2022
received:
22
02
2022
accepted:
08
08
2022
pubmed:
27
8
2022
medline:
16
11
2022
entrez:
26
8
2022
Statut:
ppublish
Résumé
Chronic thromboembolic pulmonary hypertension (CTEPH) is a life-threatening complication of a pulmonary embolism (PE) whose incidence and predictors are not precisely determined. To determine the frequency and predictors for CTEPH after a first unprovoked PE. In a randomized trial comparing an additional 18-month warfarin versus placebo in patients after a first unprovoked PE initially treated with vitamin K antagonist for 6 months, we applied recommended CTEPH screening strategies through an 8-year follow-up to determine cumulative incidence of CTEPH. CTEPH predictors were estimated using Cox models. Pulmonary vascular obstruction (PVO) and systolic pulmonary arterial pressure (sPAP) at PE diagnosis and 6 months were studied by receiver operating curves analysis. All CTEPH cases and whether they were incident or prevalent were adjudicated. During a median follow-up of 8.7 years, nine CTEPH cases were diagnosed among 371 patients, with a cumulative incidence of 2.8% (95% confidence interval [CI] 0.95-4.64), and of 1.31% (95% CI 0.01-2.60) after exclusion of five cases adjudicated as prevalent. At PE diagnosis, PVO > 45% and sPAP > 56 mmHg were associated with CTEPH with a hazard ratio (HR) of 33.00 (95% CI 1.64-667.00, p = .02) and 12.50 (95% CI 2.10-74.80, p < .01), respectively. Age > 65 years, lupus anticoagulant antibodies and non-O blood groups were also predictive of CTEPH. PVO > 14% and sPAP > 34 mmHg at 6 months were associated with CTEPH (HR 63.90 [95% CI 3.11-1310.00, p < .01]and HR 17.2 [95% CI 2.75-108, p < .01]). After a first unprovoked PE, CTEPH cumulative incidence was 2.8% during an 8-year follow-up. PVO and sPAP at PE diagnosis and at 6 months were the main predictors for CTEPH diagnosis.
Sections du résumé
BACKGROUND
Chronic thromboembolic pulmonary hypertension (CTEPH) is a life-threatening complication of a pulmonary embolism (PE) whose incidence and predictors are not precisely determined.
OBJECTIVE
To determine the frequency and predictors for CTEPH after a first unprovoked PE.
PATIENTS/METHODS
In a randomized trial comparing an additional 18-month warfarin versus placebo in patients after a first unprovoked PE initially treated with vitamin K antagonist for 6 months, we applied recommended CTEPH screening strategies through an 8-year follow-up to determine cumulative incidence of CTEPH. CTEPH predictors were estimated using Cox models. Pulmonary vascular obstruction (PVO) and systolic pulmonary arterial pressure (sPAP) at PE diagnosis and 6 months were studied by receiver operating curves analysis. All CTEPH cases and whether they were incident or prevalent were adjudicated.
RESULTS
During a median follow-up of 8.7 years, nine CTEPH cases were diagnosed among 371 patients, with a cumulative incidence of 2.8% (95% confidence interval [CI] 0.95-4.64), and of 1.31% (95% CI 0.01-2.60) after exclusion of five cases adjudicated as prevalent. At PE diagnosis, PVO > 45% and sPAP > 56 mmHg were associated with CTEPH with a hazard ratio (HR) of 33.00 (95% CI 1.64-667.00, p = .02) and 12.50 (95% CI 2.10-74.80, p < .01), respectively. Age > 65 years, lupus anticoagulant antibodies and non-O blood groups were also predictive of CTEPH. PVO > 14% and sPAP > 34 mmHg at 6 months were associated with CTEPH (HR 63.90 [95% CI 3.11-1310.00, p < .01]and HR 17.2 [95% CI 2.75-108, p < .01]).
CONCLUSION
After a first unprovoked PE, CTEPH cumulative incidence was 2.8% during an 8-year follow-up. PVO and sPAP at PE diagnosis and at 6 months were the main predictors for CTEPH diagnosis.
Identifiants
pubmed: 36017744
doi: 10.1111/jth.15866
pii: S1538-7836(22)18360-1
doi:
Substances chimiques
Anticoagulants
0
Banques de données
ClinicalTrials.gov
['NCT01894204']
Types de publication
Randomized Controlled Trial
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2850-2861Investigateurs
Francis Couturaud
(F)
Patrick Mismetti
(P)
Christophe Leroyer
(C)
Guy Meyer
(G)
Olivier Sanchez
(O)
Patrick Jego
(P)
Gilles Pernod
(G)
Elisabeth Duhamel
(E)
Karine Provost
(K)
Florence Parent
(F)
Laurent Bertoletti
(L)
Cécile Tromeur
(C)
Dominique Mottier
(D)
Marie Guégan
(M)
Solen Mélac
(S)
Aurélia Le Hir
(A)
Philippe Girard
(P)
Stéphane Lenoir
(S)
Christian Lamer
(C)
Jean François Bergmann
(JF)
Denis Wahl
(D)
Ludovic Drouet
(L)
Emilie Presles
(E)
Silvy Laporte
(S)
Patrick Chevarier
(P)
Nicolas Monte
(N)
Florence Morvan
(F)
Véronique Kouassi
(V)
Nabahats Ibrir
(N)
Gaid El Asri
(G)
Pierre Yves Salaun
(PY)
Philippe Robin
(P)
Pierre Yves Le Roux
(PY)
Luc Bressollette
(L)
Philippe Quéhé
(P)
Simon Gestin
(S)
Michel Nonent
(M)
Jérôme Bahuon
(J)
Lucille Deloire
(L)
Benjamin Planquette
(B)
Yannick Jobic
(Y)
Yves Etienne
(Y)
Romain Didier
(R)
Florent Leven
(F)
Loic Leroux
(L)
Hubert Galinat
(H)
Cédric Le Maréchal
(C)
Lénaïck Gourhant
(L)
Fanny Mingant
(F)
Karine Lacut
(K)
Emmanuelle Lemoigne
(E)
Luc De Saint Martin
(L)
Aurélien Delluc
(A)
Grégoire Le Gal
(G)
Nicolas Paleiron
(N)
Raphaël Le Mao
(R)
Christophe Pison
(C)
Philippe Guéret
(P)
Hervé Décousus
(H)
Sandrine Accassat
(S)
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2022 International Society on Thrombosis and Haemostasis.
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