Contributors: CIC Brest; Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital de la Cavale Blanche; Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO); Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM); Université de Brest (UBO)-Université de Brest (UBO); Santé Ingénierie Biologie Saint-Etienne (SAINBIOSE); Centre Ingénierie et Santé (CIS-ENSMSE); École des Mines de Saint-Étienne (Mines Saint-Étienne MSE); Institut Mines-Télécom Paris (IMT)-Institut Mines-Télécom Paris (IMT)-École des Mines de Saint-Étienne (Mines Saint-Étienne MSE); Institut Mines-Télécom Paris (IMT)-Institut Mines-Télécom Paris (IMT)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM); Centre Hospitalier Universitaire de Saint-Etienne CHU Saint-Etienne (CHU ST-E); F-Crin INvestigation Network On Venous Thrombo-Embolism CHU Saint-Etienne (Innovte); Innovations thérapeutiques en hémostase = Innovative Therapies in Haemostasis (IThEM - U1140); Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité); Hôpital Européen Georges Pompidou APHP (HEGP); Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO); Hôpital Bicêtre AP-HP, Le Kremlin-Bicêtre; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP); Pôle des Cardiopathies Congénitales du Nouveau-Né à L'adulte - Centre Constitutif Cardiopathies Congénitales Complexes M3C, Groupe Hospitalier Paris Saint-Joseph, Hôpital Marie-Lannelongue, Inserm U999, Université Paris-Saclay; Hôpital Marie-Lannelongue-Hypertension pulmonaire : physiopathologie et innovation thérapeutique (HPPIT); Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay; Centre Hospitalier Régional Universitaire de Brest (CHRU Brest); Centre Hospitalier Universitaire CHU Grenoble (CHUGA); Université Grenoble Alpes (UGA); Centre d'Investigation Clinique - Epidémiologie Clinique CHU Saint-Etienne (CIC-EC 1408); Centre Hospitalier Universitaire de Saint-Etienne CHU Saint-Etienne (CHU ST-E)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM); Université de Rennes (UR); Centre Hospitalier Universitaire de Rennes CHU Rennes = Rennes University Hospital Pontchaillou; Institut Mutualiste de Montsouris (IMM); PADIS-PE Investigators: Francis Couturaud, Patrick Mismetti, Christophe Leroyer, Guy Meyer, Olivier Sanchez, Patrick Jego, Gilles Pernod, Elisabeth Duhamel, Karine Provost, Florence Parent, Laurent Bertoletti, Cécile Tromeur, Dominique Mottier, Marie Guégan, Solen Mélac, Aurélia Le Hir, Philippe Girard, Stéphane Lenoir, Christian Lamer, Jean François Bergmann, Denis Wahl, Ludovic Drouet, Emilie Presles, Silvy Laporte, Patrick Chevarier, Nicolas Monte, Florence Morvan, Véronique Kouassi, Nabahats Ibrir, Gaid El Asri, Pierre Yves Salaun, Philippe Robin, Pierre Yves Le Roux, Luc Bressollette, Philippe Quéhé, Simon Gestin, Michel Nonent, Jérôme Bahuon, Lucille Deloire, Benjamin Planquette, Yannick Jobic, Yves Etienne, Romain Didier, Florent Leven, Loic Leroux, Hubert Galinat, Cédric Le Maréchal, Lénaïck Gourhant, Fanny Mingant, Karine Lacut, Emmanuelle Lemoigne, Luc De Saint Martin, Aurélien Delluc, Grégoire Le Gal, Nicolas Paleiron, Raphaël Le Mao, Christophe Pison, Philippe Guéret, Hervé Décousus, Sandrine Accassat
نبذة مختصرة : International audience ; Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a life-threatening pulmonary embolism's (PE) complication whose incidence and predictors are not precisely determined.Objective: To determine the frequency and predictors for CTEPH after a first unprovoked PE.Patients/methods: In a randomized trial comparing an additional 18-month warfarin versus placebo in patients after a first unprovoked PE initially treated with vitamin K antagonist for 6 months, we applied recommended CTEPH screening strategies through 8-year follow-up to determine cumulative incidence of CTEPH. CTEPH predictors were estimated using Cox models. Pulmonary vascular obstruction (PVO) and systolic pulmonary arterial pressure (sPAP) at PE diagnosis and 6 months were studied by receiver operating curves analysis. All CTEPH cases and whether they were incident or prevalent were adjudicated.Results: During a median follow-up of 8.7 years, 9 CTEPH cases were diagnosed among 371 patients, with a cumulative incidence of 2.8% (95% confidence interval [CI], 0.95-4.64), and of 1.31% (95%CI, 0.01-2.60) after exclusion of 5 cases adjudicated as prevalent. At PE diagnosis, PVO>45% and sPAP>56mmHg were associated with CTEPH with a hazard ratio (HR) of 33.00 (95%CI 1.64-667.00, p=0.02) and 12.50 (95%CI 2.10-74.80, p<0.01) respectively. Age>65 years, lupus anticoagulant antibodies and non-O blood groups were also predictive of CTEPH. PVO>14% and sPAP>34mmHg at 6-month were associated with CTEPH (HRs 63.90 [95%CI, 3.11-1310.00, p<0.01]and 17.2 [95%CI, 2.75-108, p<0.01]).Conclusion: After a first unprovoked PE, CTEPH cumulative incidence was 2.8% during 8-year follow-up. PVO and sPAP at PE diagnosis and at 6 months were the main predictors for CTEPH diagnosis.
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