■持续的胸痛症状,呼吸困难,疲劳,头昏眼花,急性肺栓塞(PE)后超过3个月和/或晕厥统称为肺栓塞后综合征(PPES)。尽管PPES越来越被认为是急性PE的重要长期后遗症,其当代发病率尚不清楚。此外,对这些患者进行进一步表型鉴定的诊断试验的应用尚不清楚.这项研究旨在确定PPES的发生率,并评估全国PE患者队列中诊断测试的使用情况。
■使用国家行政数据库进行了回顾性队列研究,临床信息DataMart数据库(OptumInsight),包括没有急性PE或肺动脉高压病史的成年患者(18岁或以上),在2016年10月1日至2018年12月31日期间诊断为急性PE。以急性PE事件为暴露,评估了PPES患者中符合PPES症状的发生率和诊断测试的利用率.
■在21,297例急性PE患者中,11,969(56.2%)出现PPES≥1种症状,这是自PE前基线以来的新发现。新的呼吸困难是最常见的,在3268/15,203(21.5%)患者中注意到,其次是2894/15,643(18.5%)患者的新的不适或疲劳。在11,969名PPES患者中,5128(42.8%)接受了≥1次诊断测试,3242(27%)接受计算机断层扫描肺血管造影,2997(25%)接受超声心动图检查,和325(2.7%)在PE后3-12个月内接受了通气-灌注扫描。在65岁以上的患者中,诊断测试的使用显着降低(调整后的比值比,0.89;95%CI,0.81-0.98)。
■与PPES一致的症状在急性PE后很常见,发生在一半以上的患者中。用于进一步表型表征的诊断成像在少于一半的PPES患者中使用。
UNASSIGNED: Persistent symptoms of chest pain, dyspnea, fatigue, lightheadedness, and/or syncope more than 3 months after an acute pulmonary embolism (PE) are collectively classified as postpulmonary embolism syndrome (PPES). Although PPES is increasingly recognized as an important long-term sequel of acute PE, its contemporary incidence is unclear. Furthermore, the utilization of diagnostic testing for further phenotypic characterization of these patients is unknown. This study aimed to define the incidence of PPES and evaluate the utilization of diagnostic tests among a national cohort of patients with PE.
UNASSIGNED: Retrospective cohort study was performed using the national administrative database, Clinformatics DataMart Database (Optum Insight), and included adult patients (18 years or older) with no history of acute PE or pulmonary hypertension, diagnosed with acute PE between October 1, 2016, and December 31, 2018. With acute PE event as the exposure, the incidence of symptoms consistent with PPES and diagnostic test utilization among patients with PPES were evaluated.
UNASSIGNED: Of 21,297 incident patients with acute PE, 11,969 (56.2%) showed ≥1 symptom of PPES, which was new since their pre-PE baseline. New dyspnea was the most common and noted in 3268/15,203 (21.5%) patients, followed by new malaise or fatigue in 2894/15,643 (18.5%) patients. Among the 11,969 patients with PPES, 5128 (42.8%) received ≥1 diagnostic test, with 3242 (27%) receiving a computed tomography pulmonary angiogram, 2997 (25%) receiving an echocardiogram, and 325 (2.7%) received a ventilation-perfusion scan within 3-12 months after PE. Significantly lower use of diagnostic testing was noted in patients older than 65 years (adjusted odds ratio, 0.89; 95% CI, 0.81-0.98).
UNASSIGNED: Symptoms consistent with PPES are common after acute PE, occurring in more than half of the patients. Diagnostic imaging for further phenotypic characterization is used in less than half of such patients with PPES.