% 0期刊文章%翟,Zhenguo %王,昏暗的i %A Lei, Jieping %A Yang, Yuanhua %A Xu, Xiaomao %A Ji, Yingqun %A Yi, Qun %A Chen, Hong %A Hu, Xiaoyun %A Liu, Zhihong %A Mao, Yimin %A Zhang, Jie %A Shi, Juhong %A Zhang, Zhu %A Wu, Sinan %A Gao, Qian %A Tao, Xincao %A Xie, Wanmu %A Wan, Jun %A Zhang, Yunxia %A Zhang, Shuai %A Zhen, Kaiyuan %A Zhang, Zhonghe %A Fang, Baomin %A Wang, Chen %A , %T Trends in risk stratification, in-hospital management and mortality of patients with acute pulmonary embolism: an analysis from China pUlmonary thromboembolism REgistry Study (CURES) %D 2021 %R 10.1183/13993003.02963-2020 %J European Respiratory Journal %P 2002963 %X Background Similar trends of management and in-hospital mortality of acute pulmonary embolism (PE) have been reported in European and American populations. However, these tendencies were not clear in Asian countries.Objectives We retrospectively analyzed the trends of risk stratification, management and in-hospital mortality for patients with acute PE through a multicenter registry in China (CURES).Methods Adult patients with acute symptomatic PE were included between 2009 and 2015. Trends in disease diagnosis, treatment and death in hospital were fully analyzed. Risk stratification was retrospectively classified by hemodynamical status and the simplified Pulmonary Embolism Severity Index (sPESI) score according to the 2014 European Society of Cardiology/European Respiratory Society guidelines.Results Among overall 7438 patients, the proportions with high (hemodynamically instability), intermediate (sPESI≥1) and low (sPESI=0) risk were 4.2%, 67.1% and 28.7%, respectively. Computed tomographic pulmonary angiography was the widely employed diagnostic approach (87.6%) and anticoagulation was the frequently adopted initial therapy (83.7%). Between 2009 and 2015, a significant decline was observed for all-cause mortality (from 3.1% to 1.3%, adjusted Pfor trend=0.0003), with a concomitant reduction in use of initial systemic thrombolysis (from 14.8% to 5.0%, Pfor trend<0.0001). The common predictors for all-cause mortality shared by hemodynamically stable and unstable patients were co-existing cancer, older age, and impaired renal function.Conclusions The considerable reduction of mortality over years was accompanied by changes of initial treatment. These findings highlight the importance of risk stratification-guided management throughout the nation.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Zhai has nothing to disclose.Conflict of interest: Dr. Wang has nothing to disclose.Conflict of interest: Dr. Lei has nothing to disclose.Conflict of interest: Dr. Yang has nothing to disclose.Conflict of interest: Dr. Xu has nothing to disclose.Conflict of interest: Dr. Ji has nothing to disclose.Conflict of interest: Dr. Yi has nothing to disclose.Conflict of interest: Dr. Chen has nothing to disclose.Conflict of interest: Dr. Hu has nothing to disclose.Conflict of interest: Dr. Liu has nothing to disclose.Conflict of interest: Dr. Mao has nothing to disclose.Conflict of interest: Dr. Zhang has nothing to disclose.Conflict of interest: Dr. Shi has nothing to disclose.Conflict of interest: Dr. Zhang has nothing to disclose.Conflict of interest: Dr. Wu has nothing to disclose.Conflict of interest: Dr. Gao has nothing to disclose.Conflict of interest: Dr. Tao has nothing to disclose.Conflict of interest: Dr. Xie has nothing to disclose.Conflict of interest: Dr. Wan has nothing to disclose.Conflict of interest: Dr. Zhang has nothing to disclose.Conflict of interest: Dr. Zhang has nothing to disclose.Conflict of interest: Dr. Zhen has nothing to disclose.Conflict of interest: Dr. Zhang has nothing to disclose.Conflict of interest: Dr. Fang has nothing to disclose.Conflict of interest: Dr. Wang has nothing to disclose. %U //www.qdcxjkg.com/content/erj/early/2021/03/25/13993003.02963-2020.full.pdf