P9. Abstract Title: Systolic Blood Pressure and Mortality in Acute Symptomatic Pulmonary Embolism

Abstract

<h3>Importance</h3> The optimal cut-off for systolic blood pressure (SBP) to define high-risk pulmonary embolism (PE) remains to be defined. <h3>Objectives</h3> To evaluate the relationship between SBP on admission and short-term mortality and other cardiovascular events in patients with acute symptomatic PE. <h3>Design, Setting and Participants</h3> The Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) Registry is an ongoing, multi-center, international, prospective registry of consecutive patients with symptomatic, objectively confirmed, acute venous thromboembolism (VTE). The current study included 39,257 patients from RIETE with acute symptomatic PE between 2001 and 2018. <h3>Main Outcomes and Measures</h3> Primary outcomes included all-cause and PE-specific 30-day mortality. Secondary outcomes included major bleeding and recurrent venous thromboembolism (VTE). <h3>Results</h3> There was a linear inverse relationship between admission SBP and 30-day all-cause and PE-related mortality that persisted after multivariable adjustment. Patients in the lower SBP strata had higher rates of all-cause death (reference: SBP 120-129 mmHg) (adjusted odds ratio [OR] 2.9, 95% confidence interval [CI] 2.0-4.2 for SBP <70 mmHg, and OR 1.7, 95% CI 1.4-2.1 for SBP 70-89 mmHg). The findings for 30-day PE-related mortality were similar (adjusted OR 4.4, 95% CI 2.7-7.2 for SBP <70 mmHg, and OR 2.6, 95% CI 1.9-3.4 for SBP 70-89 mmHg). After adjustment for all covariates, we did not find a significant relationship between admission SBP and recurrence or bleeding. <h3>Conclusions</h3> In patients with acute symptomatic PE, a low SBP portends an increased risk of all-cause and PE-related mortality. The highest mortality was observed in patients with SBP <70 mmHg.