No Difference in Short-Term Outcomes in Saddle vs Nonsaddle Pulmonary Embolism

Although patients with saddle pulmonary embolism (PE) present with more serious symptoms than patients with nonsaddle PE, there are no differences in short-term outcomes, according to a recent study published in the Mayo Clinic Proceedings.

Not much data exist to guide doctors in the management of patients with saddle PE, the researchers noted. Therefore, the goal of this study was to more closely define the clinical presentation and outcomes of a large cohort of patients with saddle PE.

A secondary aim was to compare patients with saddle PE with patients with nonsaddle PE in terms of clinical presentation and outcomes. 

The researchers examined all patients diagnosed with saddle PE from 1999 through 2014 at the Mayo Clinic in Rochester, Minnesota. They then matched those patients with a nonsaddle PE cohort. Using established criteria for comparing clinical presentation, outcomes, and management, researchers classified both groups into massive, submassive, and low-risk PE.

A total of 187 consecutive patients with saddle PE were identified. Low-risk PE was more prevalent in the nonsaddle PE group (48% vs 20%) while the saddle PE group presented more frequently with massive PE (31% vs 20%) and submassive PE (49% vs 32%).

On admission, physicians used systemic thrombolysis more frequently in patients with saddle PE (10% vs 4%; P =.04) and also during hospitalization (3.2% vs 0%; P =.03).

With the exception of mechanical ventilation (6% in saddle PE vs 1% in nonsaddle PE; P =.02), late major adverse events were similar in both groups. Overall in-hospital mortality rates were also similar (4.3% in saddle PE vs 5.4% in nonsaddle PE; P =.81).

“Although patients with saddle PE were more likely to present with massive or submassive PE, they did not seem to carry a higher risk of in-hospital mortality compared with this severity-adjusted nonsaddle PE cohort,” the researchers concluded.

“Thus optimal clinical management of patients with saddle PE should be based on the initial and delayed hemodynamic status rather than on the location and extent of the anatomic clot burden.”

Reference

Alkinj B, Pannu B, Apala D, Kotecha A, Kashyap R, Iyer VN. Saddle vs nonsaddle pulmonary embolism: clinical presentation, hemodynamics, management, and outcomes [published September 7, 2017]. Mayo Clin Proc. doi:10.1016/j.mayocp.2017.07.014