Prognostic role of embolic burden assessed at computed-tomography angiography in patients with acute pulmonary embolism: systematic review and meta-analysis.
J Thromb Haemost. 2013 Oct 17;
Authors: Vedovati MC, Germini F, Agnelli G, Becattini C
BACKGROUND: In patients with acute pulmonary embolism (PE), risk stratification is indicated for tailoring both diagnostic strategies and acute treatment. Whether the embolic burden assessed at computed tomography (CT)-angiography has a role in risk stratification in these patients is debated.
OBJECTIVE: To systematically review and perform a meta-analysis to evaluate the role of CT-assessed burden associated with embolic obstruction and embolic localization in the prognostic stratification of patients with acute PE.
METHODS: We performed a systematic search in EMBASE and Medline up until June 30th 2013. Studies reporting on 30-day outcome of patients with confirmed PE and CT-assessed embolic burden were included. Study outcome was death.
RESULTS: Thirty studies reporting on the prognostic value of CT-assessed embolic burden met the inclusion criteria for this systematic review and of these, 19 were included in the meta-analysis. Five studies (2,215 patients) were included in the analysis of localization: an association between embolus localization in the central arteries and 30-day mortality was found after heterogeneity was resolved (OR 2.24, 95% CI 1.29-3.89; I-squared 0%). No correlation was observed between obstruction index (according to Qanadli scoring-system) and 30-day mortality after heterogeneity was reduced (16 studies, 3,884 patients, OR 1.22, 95% CI 0.99-1.51, I-squared 27%).
CONCLUSION: Localization of emboli assessed at CT-angiography can be used for risk stratification in patients with acute PE. Moreover, no correlation was observed between obstruction index and prognosis. This article is protected by copyright. All rights reserved.
PMID: 24134450 [PubMed - as supplied by publisher]