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Prognostic role of embolic burden assessed at computed tomography angiography in patients with acute pulmonary embolism: systematic review and meta‐analysis
Author(s) -
Vedovati M. C.,
Germini F.,
Agnelli G.,
Becattini C.
Publication year - 2013
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/jth.12429
Subject(s) - medicine , pulmonary embolism , meta analysis , confidence interval , embolus , computed tomography angiography , odds ratio , radiology , angiography , pulmonary angiography , embolism , study heterogeneity , cardiology
Summary Background In patients with acute pulmonary embolism ( PE ), risk stratification is indicated for tailoring of both diagnostic strategies and acute treatment. Whether embolic burden assessed at computed tomography ( CT ) angiography has a role in risk stratification in these patients is debated. Objective To systematically review and perform a meta‐analysis to evaluate the role of CT ‐assessed burden associated with embolic obstruction and embolic localization in the prognostic stratification of patients with acute PE . Methods We performed a systematic search in EMBASE and MEDLINE up until 30 June 2013. Studies reporting on the 30‐day outcome of patients with confirmed PE and CT ‐assessed embolic burden were included. The study outcome was death. Results Thirty studies reporting on the prognostic value of CT ‐assessed embolic burden met the inclusion criteria for this systematic review; of these, 19 were included in the meta‐analysis. Five studies (2215 patients) were included in the analysis of localization: an association between embolus localization in the central arteries and 30‐day mortality was found after heterogeneity was resolved (odds ratio [ OR ] 2.24, 95% confidence interval [ CI ] 1.29–3.89, I 2 = 0%). No correlation was observed between obstruction index (according to the Q anadli scoring system) and 30‐day mortality after heterogeneity was reduced (16 studies, 3884 patients, OR 1.22, 95% CI 0.99–1.51, I 2 = 27%). Conclusion Localization of emboli assessed at CT angiography can be used for risk stratification in patients with acute PE . Moreover, no correlation was observed between obstruction index and prognosis.