Clinical outcomes after investigation for pulmonary embolism using CT angiography and venography

Clinical outcomes after investigation for pulmonary embolism using CT angiography and venography

The diagnosis of pulmonary embolism (PE) still requires long work-up periods and multiple tests. We aim to assess clinical outcomes after a negative investigation using a combined protocol of CT pulmonary angiography and CT venography (CTA/CTV) as a sole diagnostic test in unselected patients with s...

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Published in:Arquivos brasileiros de cardiologia Vol. 99; no. 2; pp. 740 - 746
Main Authors: Darze, Eduardo S, Braghiroli, João F M, Almeida, Ricardo V, Araújo, Enio P, Toscano, Sergio M, Araújo-Neto, César Augusto
Format: Journal Article
Language:English
Published: Brazil 01-08-2012
Subjects:
Adult
Aged
Angiography - methods
Cause of Death
Clinical Protocols
Cohort Studies
Female
Humans
Lung - diagnostic imaging
Male
Middle Aged
Outcome Assessment (Health Care)
Phlebography - methods
Pulmonary Embolism - diagnostic imaging
Radiography, Thoracic - methods
Risk Factors
Tomography Scanners, X-Ray Computed
Tomography, X-Ray Computed - methods
Venous Thromboembolism - diagnostic imaging
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Summary:The diagnosis of pulmonary embolism (PE) still requires long work-up periods and multiple tests. We aim to assess clinical outcomes after a negative investigation using a combined protocol of CT pulmonary angiography and CT venography (CTA/CTV) as a sole diagnostic test in unselected patients with suspected PE. This retrospective cohort study enrolled consecutive patients with suspected PE who were investigated with a combined CTA/CTV protocol. Patients who had an initially negative investigation and were not anticoagulated were followed for 6 months for the occurrence of recurrent venous thromboembolic events. Out of 425 patients with suspected PE, 62 (14.6%) had venous thromboembolism diagnosed on the initial CTA/CTV. The mean age was 56 ± 19 years and 61% of the population fell into the low clinical probability category. Isolated deep vein thrombosis represented 21% of all venous thromboembolic events, and when considering the whole population, CTV was associated with an increment in diagnostic yield of 3.1%. Our cohort was composed of 320 patients with initially negative CTA/CTVs and who were not anticoagulated. After 6 months of follow up, only three patients presented with recurrent thromboembolic events (0.9%; 95% CI -0.1% - 2.0%) and none was fatal. There were no PE-related deaths. Our study suggests that a diagnostic strategy that utilizes CTA/CTV as a sole diagnostic test can safely rule out PE in a low to moderate risk population and is associated with favorable outcomes with a negative predictive value of 99.1%.
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ISSN:1678-4170
DOI:10.1590/S0066-782X2012005000058