背景:亚段肺栓塞(SSPE)的发生率随着成像技术的改进而增加。SSPE治疗有临床平衡,抗凝治疗可改善死亡率或减少静脉血栓栓塞复发的证据相互矛盾。SSPE研究具有明显的异质性,并且通常缺乏充分匹配的疾病比较组。
目的:为了确定患病率,管理,和SSPE的结果,并将它们与主要患者进行比较,叶,分段,无肺栓塞(PE)。
方法:2013年至2019年在英国3家医院接受CT肺动脉造影(CTPA)的所有成年患者均纳入研究。CTPA报告是针对与体育相关的语言进行的文本挖掘,然后进一步手动筛选PE的存在和解剖位置。患者组的倾向与年龄相匹配,性别,和分析前的CTPA年份。大出血的3个月结果,VTE复发,并记录死亡。
结果:从2,055例PE诊断中确定了79例(3.8%)SSPE,和14300份CTPA报告.44例(56%)SSPE为单动脉栓子,25例(32%)为单侧多发栓子,10例(13%)为多发双侧栓子。死亡率,所有组的VTE复发和大出血在3个月时相似。87.3%的SSPE影像学报告有额外的放射学诊断,胸腔积液(30%),合并(19%),和心脏肿大(19%)是最常见的。
结论:SSPE的患病率为所有PE的3.8%,并且SSPE组中有大量的其他放射学发现可能是其症状的原因。
BACKGROUND: The incidence of subsegmental pulmonary embolism (SSPE) has increased with improvements in imaging technology. There is clinical equipoise for SSPE treatment, with conflicting evidence of improved mortality or reduced venous thromboembolism recurrence with anticoagulation. SSPE studies have significant heterogeneity and often lack adequately matched disease comparator groups.
OBJECTIVE: To determine the prevalence, management, and outcomes of SSPE and compare them to patients with main, lobar, segmental, and no pulmonary embolism (PE).
METHODS: All adult patients undergoing CT pulmonary angiography (CTPA) between 2013 and 2019, at 3 UK hospitals were included in the
study. CTPA reports were text mined for language relating to PE, and then further manually screened for the presence and anatomical location of PE. Patient groups were propensity matched by age, sex, and year of CTPA prior to analysis. 3-month outcomes of major bleeding, VTE recurrence, and death were recorded.
RESULTS: 79 (3.8%) SSPEs were identified from 2,055 diagnoses of PE, and 14,300 CTPA reports. 44 (56%) of SSPEs were single artery emboli, 25 (32%) were multiple unilateral emboli, and 10 (13%) were multiple bilateral emboli. Mortality, VTE recurrence and major bleeding were similar at 3 months across all groups. 87.3% of SSPE imaging reports had an additional radiological diagnosis, with pleural effusion (30%), consolidation (19%), and cardiomegaly (19%) being the most common.
CONCLUSIONS: The prevalence of SSPE was 3.8% of all PEs and there were a substantial number of additional radiological findings in the SSPE group that may have accounted for their symptoms.