Pulmonary vascular resistance at hospital admission is associated with early mortality in patients with intermediate-to-high-risk acute pulmonary embolism.

Acute pulmonary embolism (PE) is a critical disease with a high 30-day mortality rate in intermediate-to-high-risk (IHR) patients. Herein, we prospectively enrolled 117 patients with IHR-PE and recorded demographic, clinical, and biochemical parameters from electronic records, as well as hemodynamic variables acquired by right-heart catheterization during catheter-directed thrombolysis. After a 6-month follow-up, we retrospectively analyzed all variables. Most hemodynamic parameters were significantly higher in patients who subsequently died within the first 30 days after admission than in patients who survived, especially pulmonary vascular resistance (PVR) (9.6 ± 3.3 versus 5.5 ± 3.1, p = 0.002, respectively). In fact, PVR ≥ 6.55 Wood units (WU) was an accurate predictor of 30-day mortality, with an area under the receiver operating characteristic curve of 0.85 (95% Confidence Interval, 0.71-0.97; p = 0.007), a sensitivity of 100%, and a specificity of 70%. Our findings emphasize the urgency of assessing hemodynamic parameters in all IHR-PE patients and prompt discussion of the benefit-risk balance of right-heart catheterization in IHR-PE.