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 at hospital admission. After a 6-month follow-up, we retrospectively analyzed all variables and found that hemodynamic parameters increased significantly in patients who subsequently died within the first 30 days after discharge, especially pulmonary vascular resistance (PVR) (9.6 ± 3.3 versus 5.5 ± 3.1, p = 0.002, in non-survival and survival patients, respectively). In fact, PVR ≥ 6.55 Wood units (WU) at hospital admission 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, prompting discussion of the benefit-risk balance of right-heart catheterization in IHR-PE.