The prognostic value of electrocardiography to predict inpatient mortality in patients with acute pulmonary embolism: a retrospective cohort analysis

Raghubeer, Nishen

The prognostic value of electrocardiography to predict inpatient mortality in patients with acute pulmonary embolism: a retrospective cohort analysis

Thesis / Dissertation

2024

Publisher

University of Cape Town

Department

Department of Medicine

Faculty

Faculty of Health Sciences

Abstract

Introduction: Pulmonary embolism represents the third leading cause of mortality globally after myocardial infarction with an overall mortality of 30%. ECG findings may play a valuable role in the prognostication of patients with PE, with various ECG abnormalities proving to be reasonable predictors of haemodynamic decompensation, cardiogenic shock, and even mortality. This study aims to assess the prognostic value of electrocardiography in predicting inpatient mortality in patients with acute pulmonary embolism, as diagnosed with computed tomography pulmonary angiogram. Method: This was a retrospective cohort design study based at Tygerberg Hospital, Cape Town, South Africa. Eligible patients were identified from all CT-PA performed between 1 January 2017 and 31 December 2019. The ECGs were independently screened by two blinded emergency medicine physicians for predetermined signs that are associated with right heart strain and higher pulmonary artery pressures, and these findings were analysed to in-hospital mortality. Results: Of the included 81 patients, 61 (75%) were female. Of the 41 (51%) patients with submassive PE and 8 (10%) with massive PE, 7 (17%) and 3 (38%) suffered inpatient mortality (p=0.023) respectively. Univariate ECG analysis revealed that complete right bundle branch block (OR, 8.6; 95% CI, 1.1 to 69.9; p=0.044) and right axis deviation (OR, 5.6; 95% CI, 1.4 to 22.4; p=0.015) were significant predictors of inpatient mortality. Conclusion: Early identification of patients with pulmonary embolism at higher risk of clinical deterioration and in-patient mortality remains a challenge. Even though no clinical finding or prediction tool in isolation can reliably predict outcomes in patients with pulmonary embolism, this study demonstrated two ECG findings at presentation that were associated with a higher likelihood of inpatient mortality. This single-centre observational study with a small sample precludes concrete conclusions and a large follow-up multi-centre study is advised.

Keywords

Emergency Medicine

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