Clinical outcomes and factors associated with pulmonary infarction following acute pulmonary embolism: a retrospective observational study at a US academic centre

Ka U Lio; Oisin O'Corragain; Riyaz Bashir; Shari Brosnahan; Gary Cohen; Vladimir Lakhter; Joseph Panaro; Belinda Rivera-Lebron; Parth Rali

doi:10.1136/bmjopen-2022-067579

Clinical outcomes and factors associated with pulmonary infarction following acute pulmonary embolism: a retrospective observational study at a US academic centre

BMJ Open. 2022 Dec 29;12(12):e067579. doi: 10.1136/bmjopen-2022-067579.

Authors

Ka U Lio¹, Oisin O'Corragain², Riyaz Bashir³, Shari Brosnahan⁴, Gary Cohen⁵, Vladimir Lakhter³, Joseph Panaro⁵, Belinda Rivera-Lebron⁶, Parth Rali²

Affiliations

¹ Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA kau.lio@tuhs.temple.edu.
² Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.
³ Department of Cardiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.
⁴ Department of Pulmonary, Critical Care and Sleep Medicine, NYU Langone Health, New York City, New York, USA.
⁵ Department of Radiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.
⁶ Department of Pulmonary and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.

Abstract

Objective: Pulmonary infarction is a common clinical and radiographic finding in acute pulmonary embolism (PE), yet the clinical relevance and prognostic significance of pulmonary infarction remain unclear. The study aims to investigate the clinical features, radiographic characteristics, impact of reperfusion therapy and outcomes of patients with pulmonary infarction.

Design, setting and participants: A retrospective cohort study of 496 adult patients (≥18 years of age) diagnosed with PE who were evaluated by the PE response team at a tertiary academic referral centre in the USA. We collected baseline characteristics, laboratory, radiographic and outcome data. Statistical analysis was performed by Student's t-test, Mann-Whitney U test, Fischer's exact or χ² test where appropriate. Multivariate logistic regression was used to evaluate potential risk factors for pulmonary infarction.

Results: We identified 143 (29%) cases of pulmonary infarction in 496 patients with PE. Patients with infarction were significantly younger (52±15.9 vs 61±16.6 years, p<0.001) and with fewer comorbidities. Most infarctions occurred in the lower lobes (60%) and involved a single lobe (64%). The presence of right ventricular (RV) strain on CT imaging was significantly more common in patients with infarction (21% vs 14%, p=0.031). There was no significant difference in advanced reperfusion therapy, in-hospital mortality, length of stay and readmissions between groups. In multivariate analysis, age and evidence of RV strain on CT and haemoptysis increased the risk of infarction.

Conclusions: Radiographic evidence of pulmonary infarction was demonstrated in nearly one-third of patients with acute PE. There was no difference in the rate of reperfusion therapies and the presence of infarction did not correlate with poorer outcomes.

Keywords: respiratory medicine (see thoracic medicine); thoracic medicine; thromboembolism.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Acute Disease
Adult
Humans
Lung
Pulmonary Embolism* / complications
Pulmonary Embolism* / diagnostic imaging
Pulmonary Embolism* / epidemiology
Pulmonary Infarction*
Retrospective Studies
Risk Factors
Ventricular Dysfunction, Right*