Abstract

Abstract 1102

Introduction:

The management of saddle pulmonary embolism (PE) is controversial. Evidence about outcomes and management strategies is scarce in the literature due to the small prevalence of saddle PE. Historically it has been recommended that this group of patients should be treated aggressively.

Purpose:

To determine the prevalence and outcomes of patients diagnosed with saddle PE.

Methods:

Retrospective cohort study of consecutive patients with saddle PE diagnosed at the Ottawa Hospital between January 2007 and December 2008. Patients were included if a thrombus was present on computed tomographic pulmonary angiography (CTPA) in the main pulmonary arteries spanning the bifurcation of the main pulmonary trunk. These cases were each matched with two non-saddle controls with proximal PE (thromboemboli in the main pulmonary arteries) based on age, sex, systolic blood pressure greater than or less than 90 mmHg, and the presence or absence of cancer. Demographics, prognostic factors, treatment, and outcomes were collected. Patients were followed over a 30 day period following the diagnosis. RESULTS: A total of 32 (5%) of 724 patients with PE had a saddle event. Baseline characteristics are depicted in Table 1. Differences between the saddle case group and non-saddle control group include the presence of right ventricular dilation (59% of saddle cases vs. 22% of controls, p-value: 0.0007) and in the proportion of patients managed as outpatients (7% of saddle cases vs. 33% of controls, p-value: 0.02). At 30 days no differences were found in patients with saddle PE or proximal PE for all cause mortality (6% vs. 10%; OR: 0.64; 95% CI: 0.08–3.2), PE related mortality (0% vs. 6%; OR: 0.52; 95% CI: 0.01–6.1), major bleeding (3% vs. 5%; OR: 0.65; 95% CI: 0.02–6.4), or recurrent venous thromboembolism (6% vs. 10%; OR: 0.64; 95% CI: 0.08–3.2).

Conclusions:

Patients with saddle PE do not have a worse 30-day prognosis than patients with proximal PE matched by age, sex, systolic blood pressure, and presence of cancer.

Table 1.

Baseline characteristics, prognostic factors, treatment, and outcomes

Clinical CharacteristicsSaddle PE (n = 31)Controls (n = 62)P-value
Mean age, in years (SD) 61 (16) 61 (16) NSA 
COPD NS 
Heart Failure NS 
Previous DVT/PE NS 
Current DVT 19 18 NS 
Shortness of Breath 25 52 NS 
Syncopal Event NS 
Prognostic Factors    
Troponin-T > 0.1 ug L−1 (n)B 7 (21)B 6 (35)B NS 
D-dimer > 4000 ug L−1 (n)B 3 (14)B 3 (22)B NS 
Mean Heart Rate (SD) 108 (18) 99 (18) NS 
RV Dilation (%) 19 (59) 14 (22) 0.0007 
Treatment    
Outpatient Management 21 0.02 
Thrombolytic Therapy NS 
Clinical CharacteristicsSaddle PE (n = 31)Controls (n = 62)P-value
Mean age, in years (SD) 61 (16) 61 (16) NSA 
COPD NS 
Heart Failure NS 
Previous DVT/PE NS 
Current DVT 19 18 NS 
Shortness of Breath 25 52 NS 
Syncopal Event NS 
Prognostic Factors    
Troponin-T > 0.1 ug L−1 (n)B 7 (21)B 6 (35)B NS 
D-dimer > 4000 ug L−1 (n)B 3 (14)B 3 (22)B NS 
Mean Heart Rate (SD) 108 (18) 99 (18) NS 
RV Dilation (%) 19 (59) 14 (22) 0.0007 
Treatment    
Outpatient Management 21 0.02 
Thrombolytic Therapy NS 
A

P-values greater than 0.05 are defined as not statistically significant (NS).

B

Number of cases or controls that had Troponin-T and D-dimer tests performed.

C

Non-hypotensive cases (n = 28) and matched controls (n = 56) analyzed.

Disclosures:

No relevant conflicts of interest to declare.

Author notes

*

Asterisk with author names denotes non-ASH members.