Burden of atherosclerosis and outcomes of acute pulmonary embolism : a post hoc analysis of the Hokusai‐VTE trial

Abstract

Background: The burden of atherosclerosis may have prognostic implications for patients affected by venous thromboembolism (VTE). We aimed to assess the association of the presence and extent of atherosclerotic disease with long‐term clinical outcomes in patients with acute pulmonary embolism (PE). Methods: In patients with PE from the Hokusai‐VTE trial, we assessed the association between the presence of atherosclerotic disease in multiple (polyvascular disease), one, or no vascular territories (coronary, cerebral, and/or peripheral arteries) and 1‐year risk of VTE or PE recurrence, major bleeding, and all‐cause death. We used univariable and multivariable Cox regression analysis, with adjustment for relevant comorbidities and anticoagulation modeled as a time‐varying covariate. Results: Of 2800 patients, 67 (2.4%) had polyvascular and 357 (12.7%) had single vascular atherosclerotic disease. During 12‐month follow‐up, recurrent VTE was reported for a total of 356 patients, including 208 PE events. A total of 52 patients had a major bleeding event and 91 deaths were recorded. Polyvascular atherosclerotic disease was strongly associated with VTE (adjusted hazard ratio,1.91 [95% CI, 1.05–3.49]) and PE recurrence (adjusted hazard ratio, 2.06 [95% CI, 1.03–4.16]). Polyvascular and single vascular disease were associated with major bleeding and all‐cause death in univariable analysis; however, these associations attenuated after adjustment. Conclusions: The pre‐existing burden of atherosclerosis may have prognostic value with respect to secondary prevention in patients who experienced an acute PE. Optimization of overall cardiovascular risk may be considered by management studies in the follow‐up of this patient population. Registration: URL: www.clinicaltrials.gov; Unique identifier: identifier: NCT00986154