ArticlesAcute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER)*
Introduction
Despite advances in diagnosis and therapy, pulmonary embolism (PE) remains poorly understood, with wide discrepancies in reported rates of mortality and recurrence.1, 2, 3, 4, 5 Therefore, we organised the International Cooperative Pulmonary Embolism Registry (ICOPER) and analysed prospective cohort data.
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Patients
We registered 2454 consecutive eligible patients with PE at 52 hospitals in seven countries between January, 1995 and November, 1996. Countries in Europe reported to the coordinating centre in Bologna, and those in North America to the Boston coordinating centre.
Inclusion criteria were acute PE (with or without symptoms) diagnosed by the attending physician within 31 days of symptom onset, or major PE first discovered at necropsy. ICOPER accepted without independent review the diagnoses and
Results
Overall, 86·0% (2110) of ICOPER patients had PE proven by necropsy, high-probability lung scan, pulmonary angiogram, or venous ultrasound scan of the deep leg veins in the presence of high clinical suspicion. At the time of enrolment, 88·9% (2182) of patients were symptomatic and haemodynamically stable; 4·2% (103) were haemodynamically unstable; and 6·9% (169) were symptom-free. In 61 patients major PE was first discovered at necropsy. The mean age was 62·3 years (median 66; range 4 months to
Discussion
Despite modern methods for diagnosis and treatment, PE continues to have a high mortality rate at 3 months. 75% of the deaths occurred during the initial hospital admission for PE. These deaths are most probably due to recurrent PE, and the frequency might be lowered if more intensive anticoagulation was used.6 In ICOPER, thrombolytic-treated patients had an intracranial haemorrhage rate of 3·0%, which is somewhat higher than the rate of 1·9% in a previously reported overview of 312 patients
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Study organisation given at the end of paper