Abstract 4137138: Incidence and Risk factors of Early Mortality in Symptomatic Acute PE: Recent Insights from the COMMAND VTE Registry-2

Background: Acute pulmonary embolism (PE) remains a major health burden with substantial morbidity and mortality. Over the past decade, the acute phase management of venous thromboembolism (VTE) has undergone considerable change. These includes a decline in the use of thrombolytic therapy and inferior vena cava filter, the widespread adoption of direct oral anticoagulant (DAOCs), and the increase in early discharge and initial outpatient treatment facilitated by DOACs. Given these advancements, it is crucial to reassess early mortality risk factors in patients with PE. Objectives: This study aimed to elucidate the mortality and prognostic factors for 30-day early mortality in patients with acute symptomatic PE in recent years. Methods: We utilized the data from the COMMAND VTE Registry-2, a multicenter registry, enrolling 5197 consecutive VTE patients across 31 centers in Japan between January 2015 and August 2020. We selected 2020 patients who presented with acute symptomatic PE. We investigated prognostic factors for early mortality in acute symptomatic PE using the multivariable hazard model. Results: In the entire study population, the mean age was 67.3±15.2 years, with 59.3% of patients being women. Active cancer was reported in 26.2%. Massive PE was observed in 7.3% (n=147), sub-massive PE in 42.6% (n=860), and non-massive PE in 44.2% (n=892). During follow-up period of 30 days, 114 patients had died, resulting in the cumulative overall mortality rate of 5.6%. Death was considered to be due to PE in 54 patients (47.4% of deaths). Patients who died within 30-days were more often male and older than those in the survivor group (44.2% vs. 59.9%, P=0.0396) (70.1±15.6 vs. 67.1±15.2, P=0.0368). Multivariable analysis identified active cancer (HR 3.01 [95%CI 2.00-4.53]), hypotension (HR 2.91 [95% CI 1.92-4.40]), tachycardia (HR 2.17 [95%CI 1.42-3.30]), hypoxemia (HR 1.97 [95%CI 1.15-3.37]), leucocytes (<4000, 12000<) (HR 1.80 [95%CI 1.22-2.68]) and age (≥ 80 years) (HR 1.69 [95%CI 1.10-2.58]) were independent prognostic factors for early mortality in acute symptomatic PE. Conclusions: In this large VTE registry from recent years, several independent prognostic factors for 30-day early mortality in acute symptomatic PE were identified, consisting of active cancer, hypotension, tachycardia, hypoxemia, leucocytes (<4000, 12000<) and age (≥ 80 years).