Abstract
<title>Abstract</title> <p>Background Pulmonary embolism (PE) is a major cardiovascular emergency associated with high early mortality and morbidity [1, 2]. Rapid clinical identification, prompt risk stratification, and timely intervention are essential to mitigate mortality [3, 7]. We aimed to evaluate the clinical spectrum, diagnostic workup, treatment strategies, and predictors of in-hospital mortality among patients with acute PE admitted to a tertiary care referral center in South India. Methods This prospective observational study enrolled 110 consecutive patients with computed tomography pulmonary angiography (CTPA)-confirmed acute PE admitted to Nizam’s Institute of Medical Sciences (NIMS), Hyderabad, between July 2021 and July 2022. Baseline demographics, underlying risk factors, presenting features, diagnostic findings, therapeutic strategies, and clinical outcomes were analyzed. Multivariate logistic regression was performed to identify independent predictors of in-hospital mortality. Results The mean age was 47.3 +/- 14.0 years, with a subtle male predominance (51.8%, n = 57). Common risk factors included prolonged bed-ridden status (38.1%), surgery within the preceding three weeks (34.5%), obesity (24.5%), and active malignancy (12.7%). Concurrent deep vein thrombosis (DVT) was documented in 62.7% of patients. Dyspnea (80.9%), palpitations (69.1%), and orthopnea/paroxysmal nocturnal dyspnea (52.7%) were the primary presenting symptoms; sinus tachycardia (80.9%), elevated jugular venous pressure (69.1%), and hypotension (33.6%) were the primary physical signs. On CTPA, proximal thrombus involvement was observed in 43.6% of patients, while 56.4% had distal/lobar/segmental occlusion. Hemodynamically, 33.6% had massive PE and 21.8% had submassive PE. Systemic thrombolytic therapy was administered in 19.1% (n = 21) of patients, predominantly using streptokinase (13.6%). Overall in-hospital mortality was 26.4% (n = 29). On multivariate analysis, active malignancy (\(\:\text{p}<0.005\)), systolic blood pressure \(\:<100\) mmHg (\(\:\text{p}<0.001\)), arterial oxygen saturation \(\:<90\text{\%}\) (\(\:\text{p}<0.005\)), proximal thrombus location on CTPA (\(\:\text{p}<0.010\)), right ventricular (RV) dysfunction on echocardiography (\(\:\text{p}<0.005\)), and intracranial neoplasm (\(\:\text{p}<0.005\)) were significant independent predictors of mortality. Conclusion Acute PE in this cohort presented with a high burden of massive/submassive cases and significant in-hospital mortality. Early risk stratification combining clinical parameters, echocardiographic RV dysfunction, and anatomical burden on CTPA is critical to identify high-risk subset patients who may benefit from aggressive advanced reperfusion therapies.</p>