Relationship Between Pulmonary Embolism Severity and Long-Term Risk of VTE Recurrence

In patients with pulmonary embolism (PE), long-term risk of recurrent venous thromboembolism (VTE) did not significantly differ according to PE severity, according to an analysis of data from the COMMAND VTE Registry. These data were published in the International Journal of Cardiology.

“There is a paucity of data on the long-term clinical outcomes according to the severity of PE at initial diagnosis,” wrote the study authors.

The COMMAND VTE Registry enrolled 3,027 consecutive patients with acute symptomatic VTE. For this study, the investigators analyzed a subcohort of 1,715 patients with PE. Patients were divided according to PE severity: massive, sub-massive, and low risk. Overall, 179 patients (10%) had massive PE, 742 (43%) had sub-massive PE, and 794 (46%) had low-risk PE.

At three months the researchers conducted a landmark analysis and found comparable cumulative incidences of recurrent VTE between the three groups. Risk of recurrent VTE was 2.9% in patients with massive PE, 4.2% in those with sub-massive PE, and 3.3% among low-risk PE patients (P = 0.061). This relationship continued after three months as well. At five years, the risk of recurrent VTE was 4.3%, 8.8%, and 7.8%, respectively (P = 0.47).

After adjustment for confounders, differences in recurrent VTE risk in massive PE relative to low-risk PE after three months remained statistically insignificant (adjusted hazard ratio = 0.54, 95% confidence interval, 0.13 to 1.51, P = 0.27). The authors noted that patients with baseline massive PE did have more frequent presentations with severe recurrent PE relative to patients with sub-massive or low-risk PE.

“In the current real-world large registry, the long-term risk of overall recurrent VTE in patients with massive PE at initial diagnosis did not significantly differ from those with sub-massive and low-risk PE beyond 3 months, although patients with massive PE at initial diagnosis more frequently developed recurrent VTE as PE with severe clinical presentation,” the authors concluded.