Clinical Characteristics and Prognosis of Pulmonary Embolism Caused by Economy Class Syndrome

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PE: pulmonary embolism." ] ] ] "textoCompleto" => "IntroductionPulmonary embolism (PE) is a disease with a wide spectrum of clinical manifestations, prognoses, and treatments.<a class="elsevierStyleCrossRef" href="#bib0135">1</a> Depending on the patient's hemodynamic status and right ventricular function at the time of diagnosis, the disease is classified as high risk PE (formerly called massive PE), which is characterized by the presence of arterial hypotension or shock, intermediate risk PE (formerly submassive PE) that occurs in normotensive patients with right ventricular dysfunction and myocardial damage, or low risk PE, in which the patient is hemodynamically stable and right ventricular function is normal.<a class="elsevierStyleCrossRefs" href="#bib0140">2–4</a>However, the short-term prognosis of patients with acute symptomatic PE depends not only on the severity of the presentation of the PE, but also on the patient's baseline characteristics and the factor that triggered the thrombotic event. For example, patients with PE associated with cancer have a significantly poorer prognosis than patients with PE due to medical immobilization,<a class="elsevierStyleCrossRef" href="#bib0155">5</a> while patients with PE due to major surgery have the best short-term prognosis.<a class="elsevierStyleCrossRef" href="#bib0160">6</a> Several studies have shown that prolonged air travel (economy class syndrome [ECS]) is a risk factor for acute symptomatic PE.<a class="elsevierStyleCrossRefs" href="#bib0165">7–9</a> However, the clinical presentation and the short-term prognosis of patients with ECS is still poorly defined.The aim of this study was to analyze the baseline characteristics of a cohort of patients with acute symptomatic PE, stratified according to the causative risk factor (ECS vs others). We also compared the short-term prognosis of patients with PE due to ECS with that of patients with idiopathic PE, or PE caused by cancer, immobilization, or surgery.MethodDesignWe conducted an observational, retrospective study to examine the baseline characteristics and short-term prognosis of a cohort of patients with stable and unstable acute symptomatic PE.Patients and Selection CriteriaAll patients with a diagnosis of symptomatic acute PE from the emergency department of the Hospital Ramon y Cajal (Madrid, Spain) between January 2003 and June 2016 were included consecutively. The diagnosis of PE was confirmed by computed tomography (CT) angiography findings of a partial or complete intraluminal defect surrounded by contrast medium or complete occlusion of a pulmonary artery in 2 consecutive CT slices.<a class="elsevierStyleCrossRef" href="#bib0180">10</a> PE was diagnosed by ventilation/perfusion scintigraphy in patients with a high probability of PE according to PIOPED criteria<a class="elsevierStyleCrossRef" href="#bib0185">11</a> (at least 1 segmental perfusion defect or 2 subsegmental defects with normal ventilation), or with clinical suspicion of PE, an inconclusive scintigraphy and diagnostic ultrasound of the lower limbs showing incomplete compressibility of the venous lumen as a sign of deep vein thrombosis (DVT).<a class="elsevierStyleCrossRef" href="#bib0190">12</a>InterventionsPatients received low molecular weight heparin (LMWH) at weight-adjusted doses every 12h for at least 5 days. Vitamin K antagonists were started along with LMWH between day 1 and day 3 of treatment, and LMWH was suspended when the international normalized ratio (INR) was stable and greater than 2.0. INR levels were monitored in accordance with the local practices of the center.Recanalization treatment (thrombolytics, fragmentation or embolectomy) was used in hemodynamically unstable patients at the discretion of the treating physician. In general, mechanical fragmentation and embolectomy were reserved for unstable patients with contraindications for thrombolysis. A vena cava filter was inserted in patients with contraindication for anticoagulation (active bleeding or high risk of bleeding).Definitions According to Causative FactorStudy patients were classified into one or more of the following groups:ECS, in patients who had made a journey of more than 4h duration in the month before the diagnosis of PE, irrespective of the mode of transport.Cancer, active or in treatment, in the year prior to the diagnosis of PE.Surgery in the month prior to the diagnosis of PE.Immobilization, in non-surgical patients bedridden for 4 or more days in the month prior to the diagnosis of PE.Pregnancy, postpartum period, use of oral contraceptives in the month prior to the diagnosis of PE.Idiopathic, in the absence of any of the above-mentioned triggers.Study EpisodesThe primary endpoint was defined as all-cause mortality in the month prior to diagnosis. Secondary endpoints were death due to the PE itself, objectively confirmed non-fatal thromboembolic relapse, and non-fatal major bleeding in the month following diagnosis.Diagnostic criteria of non-fatal thrombotic recurrence were the presence of a new intraluminal defect on CT angiogram, or a new ventilation/perfusion defect on lung scintigraphy; new non-compressible venous segment or increase in the diameter of the thrombus by at least 4mm on lower limb ultrasonography.<a class="elsevierStyleCrossRef" href="#bib0195">13</a>Non-fatal major bleeding was defined as bleeding requiring transfusion of at least 2 units of packed red blood cells, bleeding requiring surgery, or brain, retroperitoneal, or joint bleeding.<a class="elsevierStyleCrossRef" href="#bib0200">14</a>Statistical AnalysisContinuous variables were expressed as mean±standard deviation or median (interquartile range), as appropriate, and were compared with the Student t test or the Mann–Whitney U test for asymmetric data. Categorical variables were represented as percentages and compared using the Chi-square test or Fisher's exact test, if necessary.Accumulated incidence curves were estimated using the Kaplan–Meier method and compared using the log rank test.<a class="elsevierStyleCrossRefs" href="#bib0205">15,16</a> A multivariate logistic regression model was constructed to evaluate the possible association between ECS and mortality.<a class="elsevierStyleCrossRef" href="#bib0215">17</a> A maximum model of 14 variables selected on the basis of the published experience and expert opinion was developed. Variables were: (a) age; (b) sex; (c) chronic obstructive pulmonary disease (COPD); (d) congestive heart failure (CHF); (e) heart rate; (f) systolic blood pressure; (g) dyspnea; (h) chest pain; (i) syncope; (j) ECS; (k) cancer; (l) recent surgery; (m) immobilization, and (n) simplified Pulmonary Embolism Severity Index (PESI) scale.<a class="elsevierStyleCrossRef" href="#bib0220">18</a> The analysis was constructed on the basis of the maximum model and by backward elimination of variables. Confounding variables (i.e., the coefficient of the variable evaluated was modified by more than 10% when the confounding variable was eliminated from the model) of the effect of ECS on the primary endpoint were maintained in the model. Odds ratios (OR) and corresponding 95% confidence intervals (CI) were calculated.SPSS software (version 19.0, SPSS Inc., Chicago, Illinois, USA) was used for the statistical analysis. Results with a 2-tailed value of P<.05 were considered statistically significant.ResultsPatientsDuring the study period, 12629 patients with suspected acute symptomatic PE were evaluated and diagnosis was confirmed in 2445 (19.4%). Of these, 113 were lost to follow-up, so the final sample consisted of 2333 patients (1089 men and 1244 women), 95% of the population evaluated (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). No statistically significant differences were found between the baseline variables of the patients who were included and those who were excluded. Approximately 70% of patients (1659/2333) were diagnosed by chest CT angiogram, 744 (32%) by high probability ventilation/perfusion scintigraphy, while 76 (3%) had negative chest studies and DVT confirmed by ultrasound of the lower limbs. Some patients had several simultaneous positive diagnostic tests.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Study patient characteristics are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The number of patients treated with inferior vena cava filters was low (2.2%; 52 of 2333 patients). Four percent (103 of 2333 patients) were treated with thrombolytics. Fewer patients in the ECS group were men (34% versus 47%; P<.01), and ECS patients were younger (55.8±14.2 vs 69.6±16.5; P<.001) and had less COPD (0% vs 8.1%; P<.001), heart failure (0.8% vs 6.0%; P<.01), cancer (4.8% vs 21%; P<.001), and history of recent hemorrhage (0% vs 3.4%; P=.03) A higher proportion of patients with ECS was classified as low risk according to the simplified PESI scale (45% vs 29%; P<.001). PE was more severe in patients with ECS, who presented more frequently with syncope (48% versus 14%; P<.001), tachycardia (37% vs 21%; P<.001), right ventricular dysfunction (31% vs 19%; P<.01), and myocardial damage (57% vs 28%; P<.001) than patients with idiopathic PE or PE due to other etiologies. More patients with ECS had residual DVT (45% vs 57%; P=.02). With regard to treatment, more patients with ECS received thrombolytic treatment (9.8% vs 4.1%; P<.01).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Of the 2333 patients, 213 (9.1%; 95% CI: 8.0–10.4) died during the first 30 days of follow-up (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Seventy-six patients (36%) died due to their PE, 59 (28%) due to cancer, 25 (12%) due to infection, 10 (4.7%) due to heart failure, 8 (3.8%) due to bleeding, and 35 (16%) due to other causes. Seventy-five patients presented a secondary event: 21 had an objectively confirmed thrombotic recurrence, 50 patients had non-fatal major bleeding, and 4 presented simultaneous bleeding and recurrence.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Patients with ECS had a significantly lower risk of all-cause death than patients with idiopathic PE or PE from other causes (log rank test, P<.01; <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Mortality due to the PE itself in the first month of follow-up was similar in ECS and non-ECS patients (log rank test, P=.11). None of the ECS patients had thromboembolic recurrence, and only 1 (0.8%) had non-fatal major bleeding in the first 30 days of follow-up.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>In the univariate analysis, age >80 years (OR: 1.82; 95% CI: 1.36–2.44; P<.001), some comorbidities, including COPD (OR: 2.15; 95% CI: 1.41–3.28; P<.001), heart failure (OR: 2.59; 95% CI: 1.64–4.07; P<.001), cancer (OR: 3.60; 95% CI: 2.68–4.82; P<.001), together with medical immobilization (OR: 1.82; 95% CI: 1.33–2.49; P<.001), clinical presentation [tachycardia (OR: 1.55; 95% CI: 1.13–2.12; P<.01) and hypotension (OR: 2.90; 95% CI: 1.99–4.23; P<.001)], and high risk on the simplified PESI scale (OR: 7.25; 95% CI: 4.11–12.80; P<.001) significantly increased the risk of all-cause death in the 30 days after PE diagnosis (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). In contrast, a history of recent surgery (OR: 0.39; (95% CI: 0.19–0.81; P<.01) and ECS (OR: 0.16; 95% CI: 0.04–0.63; P<.01) were associated with a statistically significant reduction in the risk of death. In the multivariate analysis, ECS was independently associated with all-cause death during the first 30 days of follow-up (OR: 0.22; 95% CI: 0.05–0.94, P=.04) (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>). ECS was not independently associated with death due to the PE itself during the first 30 days of follow-up (OR: 0.37; 95% CI: 0.05–2.77; P<.33).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia>DiscussionThis study analyzed the clinical presentation and short-term prognosis of ECS in a large series of patients with acute symptomatic PE. Our results indicate that PE in patients with ECS more frequently causes right ventricular dysfunction and myocardial damage than idiopathic PE or PE triggered by other causes. However, the short-term prognosis of these patients is excellent.We found that, while patients with PE caused by ECS are younger and have less comorbidity (e.g., COPD, heart failure) than patients with idiopathic PE or PE due to other causes, its form of presentation is more severe, and it began more frequently with syncope, tachycardia, and hypotension, all factors for poor prognosis in the acute phase of the PE.<a class="elsevierStyleCrossRefs" href="#bib0225">19–22</a> Interestingly, right ventricular dysfunction and myocardial necrosis were significantly more frequent in these patients. These results are similar to those of a previous study that evaluated the form of presentation of patients with ECS.<a class="elsevierStyleCrossRef" href="#bib0245">23</a> The reasons why these patients present this way remain unclear, but some mechanisms may be responsible. Hypoxia in the aircraft cabin increases pulmonary arterial pressure and could worsen right ventricular function.<a class="elsevierStyleCrossRef" href="#bib0250">24</a> Residual DVT was less frequent in patients with ECS than in patients with idiopathic PE or PE triggered by other causes, perhaps because in these patients the entire clot formed in the lower limbs breaks free, causing PE with a larger clot burden.Despite their more severe PE, the short-term prognosis of these patients is excellent, and significantly better than that of patients with PE due to cancer or immobilization. This can be explained by the fact that while early death (in the initial days) among patients with PE is a result of right ventricular failure, late mortality is the result of patient comorbidity.<a class="elsevierStyleCrossRef" href="#bib0255">25</a>What is the clinical significance of this study? Clinical practice guidelines advise against the use of fibrinolytic treatment in patients with intermediate risk PE. The PEITHO study analyzed the efficacy and safety of treatment with tenecteplase in normotensive patients with right ventricular dysfunction and myocardial damage. Although fibrinolytics significantly reduced the hemodynamic collapse of these patients, mortality was not affected, and severe bleeds were significantly more frequent in those who received fibrinolysis.<a class="elsevierStyleCrossRef" href="#bib0260">26</a> Our results support this recommendation in the subgroup of patients with PE due to ECS. Although this presentation is more serious (e.g., intermediate-high risk PE), prognosis is excellent when conventional anticoagulation is administered.Our study has some limitations. Firstly, as this is an analysis of a historical cohort composed of patients from a single hospital, it is subject to the biases inherent to this type of study and results are not generalizable. However, it represents an unselected population of PE patients seen in routine clinical practice in our setting, so it may be considered an ideal series for evaluating the form of presentation and prognosis of patients with ECS. Secondly, we could not measure the clot burden of our patients, so we cannot establish an association between the degree of pulmonary artery obstruction and the presence or absence of right ventricular dysfunction.In conclusion, our results show that patients with PE caused by ECS have less comorbidity than patients with idiopathic PE or PE due to other causes. Although these patients more frequently present with high-intermediate risk PE, their short-term prognosis is excellent with conventional anticoagulation. Well-designed studies are needed to understand why these patients more often present right ventricular dysfunction and myocardial damage in the acute phase of the PE.Conflict of InterestThe authors state that they have no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres888161" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec874132" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres888160" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec874131" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Method" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Design" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Patients and Selection Criteria" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Interventions" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Definitions According to Causative Factor" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Study Episodes" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Statistical Analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0045" "titulo" => "Results" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Patients" ] ] ] 7 => array:2 [ "identificador" => "sec0055" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflict of Interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-12-05" "fechaAceptado" => "2017-02-18" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec874132" "palabras" => array:3 [ 0 => "Pulmonary embolism" 1 => "Economy-class syndrome" 2 => "Prognosis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec874131" "palabras" => array:3 [ 0 => "Tromboembolia de pulmón" 1 => "Síndrome de clase turista" 2 => "Pronóstico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveClinical presentation and short-term prognosis of patients with travel-associated acute pulmonary embolism (PE) (i.e., economy class syndrome [ECS]) is not well understood. MethodsIn this retrospective cohort study of patients with acute PE identified from a single center registry, we assessed the clinical presentation and the association between ECS and the outcomes of all-cause mortality, PE-related mortality, nonfatal venous thromboembolism and nonfatal major bleeding rates through 30days after initiation of PE treatment. ResultsOf the 2333 patients with acute symptomatic PE, 124 (5.3%; 95% confidence interval, 4.4%–6.3%) had ECS. Patients with ECS were younger and had fewer comorbid diseases (recent bleeding, chronic obstructive pulmonary disease, congestive heart failure), but they presented with more signs of clinical severity (syncope [48% vs 14%; P<.001], tachycardia [37% vs 21%; P<.001], right ventricular dysfunction [31% vs 19%; P<.01] and myocardial injury [57% vs 28%; P<.001]) compared to those without ECS. Regression analyses showed a significantly lower risk of all-cause mortality for patients with ECS compared to patients without ECS (1.6% vs 9.6%; P<.01). We did not detect a difference in PE-related mortality at 30days between those with and those without ECS (0.8% vs 3.1%; P=.18). ConclusionsPE patients with ECS are younger and have fewer comorbid diseases compared to those without ECS. Though they present with more signs of clinical severity, their short-term prognosis is excellent." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoNo se conocen suficientemente las características clínicas y el pronóstico de los pacientes con tromboembolia de pulmón (TEP) aguda sintomática asociada a los viajes prolongados (síndrome de clase turista [SCT]). MétodosSe analizaron retrospectivamente las características basales de los pacientes con TEP aguda y se estratificaron según el factor de riesgo desencadenante. Se determinaron la mortalidad por todas las causas, la mortalidad por la propia TEP, las recurrencias trombóticas no fatales y los sangrados mayores no fatales durante los primeros 30días de seguimiento. ResultadosDe los 2.333 pacientes incluidos, un total de 124 (5,3%; intervalo de confianza del 95%: 4,4–6,3) fueron diagnosticados de TEP secundaria a SCT. Estos pacientes fueron más jóvenes, presentaron menos frecuentemente comorbilidad y más frecuentemente síncope (48% vs 14%; p<0,001), taquicardia (37% vs 21%; p<0,001), disfunción de ventrículo derecho (VD) (31% vs 19%; p<0,01) y daño miocárdico (57% vs 28%; p<0,001) que los demás pacientes con TEP. La mortalidad por todas las causas a 30días fue significativamente menor para los pacientes con TEP secundaria a SCT (1,6% vs 9,6%; p<0,01). La mortalidad a 30días por TEP no fue diferente entre los dos grupos de pacientes (0,8% vs 3,1%; p=0,18). ConclusionesLos pacientes con TEP y SCT son más jóvenes y tienen menos comorbilidad que los demás pacientes con TEP. Aunque se presentan más frecuentemente con disfunción de VD y daño miocárdico, el pronóstico a corto plazo es excelente." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Abellás M, Menéndez A, Morillo R, Jara-Palomares L, Barrios D, Nieto R, et al. Características clínicas y pronóstico de la tromboembolia pulmonar secundaria al síndrome de clase turista. Arch Bronconeumol. 2017;53:495–500." ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1536 "Ancho" => 2503 "Tamanyo" => 146393 ] ] "descripcion" => array:1 [ "en" => "Study patient flow chart. PE: pulmonary embolism." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1982 "Ancho" => 2343 "Tamanyo" => 148964 ] ] "descripcion" => array:1 [ "en" => "Survival curve for the primary endpoint. Log rank test, P<.01." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "BNP, brain natriuretic peptide; cTnI, cardiac troponin I; COPD, chronic obstructive pulmonary disease; DVT, deep vein thrombosis; ECS, economy class syndrome; PESI, Pulmonary Embolism Severity Index; SBP, systolic blood pressure." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">All n=2333<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Idiopathic n=982 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ECS n=124 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cancer n=462 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Immobilization n=477 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Surgery n=200 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top">Clinical characteristics, n (%)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age, years, median (25–75 percentiles) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74 (59–81) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75 (63–82) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54 (44–67) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72 (61–78) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">79 (68–86) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68 (52–77) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age >80 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">624 (27%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">285 (29%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">79 (17%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">210 (44%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 (18%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1089 (47%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">510 (52%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42 (34%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">252 (55%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">178 (37%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88 (44%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top">Comorbidity, n (%)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">History of severe bleeding<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74 (3.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (1.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (2.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42 (8.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (5.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">COPD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">180 (7.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80 (8.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32 (6.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53 (11%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (4.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Heart failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">134 (5.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62 (6.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (2.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 (10%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (2.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top">Signs and symptoms at diagnosis</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Syncope \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">372 (16%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">156 (16%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60 (48%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56 (12%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74 (16%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (10%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chest pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1019 (44%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">450 (46%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52 (42%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">174 (38%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">158 (33%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93 (47%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dyspnea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1681 (72%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">706 (72%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78 (63%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">329 (71%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">363 (76%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">147 (74%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DVT symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">545 (23%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">239 (24%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (19%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">108 (23%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92 (19%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 (17%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Heart rate ≥110/min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">498 (21%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">206 (21%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46 (37%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93 (20%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">115 (24%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42 (21%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hemoglobin saturation (SaO2) <90% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">643 (28%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">290 (30%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 (23%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">207 (45%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">167 (35%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53 (27%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SBP <90mmHg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">94 (4.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 (3.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (3.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (5.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 (6.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (4.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top">Simplified PESI (18)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Low risk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">693 (30%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">356 (36%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56 (45%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97 (20%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69 (34%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">High risk \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1640 (70%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">626 (64%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68 (55%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">462 (100%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">380 (80%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">131 (66%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top">Clinical laboratory tests</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hemoglobin, g/dl, median (percentiles 25–75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.3 (12.0–14.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.9 (12.7–15.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.6 (12.6–14.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.4 (10.8–13.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.9 (11.9–13.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.3 (10.7–13.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Creatinine >2mg/dl (n=2306) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89 (3.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 (5.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (1.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (2.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 (5.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (2.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top">Ultrasound and biomarkers, n (%)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Concomitant diseases (n=1784) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1010 (57%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">422 (43%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 (35%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">218 (47%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">207 (43%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72 (36%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Right ventricular dysfunction (n=1275) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">458 (36%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">228 (23%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 (31%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 (13%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89 (19%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32 (16%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BNP >200pg/dl (n=917) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">446 (49%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">221 (23%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (15%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70 (15%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">110 (23%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 (16%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top">Treatment, n (%)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Thrombolysis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">103 (4.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51 (5.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (9.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (1.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (4.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Inferior vena cava filter \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52 (2.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 (2.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (2.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (3.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (3.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1501019.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Some patients presented several risk factors simultaneously." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Since patients with PE due to hormone replacement therapy, use of oral contraceptives, pregnancy, postpartum, or hereditary thrombophilia were not included in the analysis, the sum of patients of the columns is not 2333." ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "In the previous month." ] ] ] "descripcion" => array:1 [ "en" => "Baseline Characteristics and Treatment of Study Subjects.<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>" ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">All n=2333 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Idiopathic n=982 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ECS n=124 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cancer n=462 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Immobilization n=477 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Surgery n=200 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">All-cause death \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">213 (9.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54 (5.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (1.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92 (19.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65 (13.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (4.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Death due to PE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76 (3.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (1.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (5.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 (6.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (1.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Non-fatal recurrence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 (1.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (0.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (1.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (1.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (3.0%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Non-fatal bleeding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54 (2.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 (2.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (2.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (2.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (2.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1501018.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "a" "nota" => "Some patients presented several risk factors simultaneously." ] ] ] "descripcion" => array:1 [ "en" => "Mortality and Non-Fatal Adverse Events During the First 30 Days of Follow-Up.<a class="elsevierStyleCrossRef" href="#tblfn0020">a</a>" ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; ECS, economy class syndrome; HR, heart rate; OR, odds ratio; PESI, Pulmonary Embolism Severity Index; SBP, systolic blood pressure." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Predictive Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Unadjusted OR (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age >80 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.82 (1.36–2.44) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.17 (0.88–1.55) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.28 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">COPD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.15 (1.41–3.28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CHF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.59 (1.64–4.07) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HR ≥110/min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.55 (1.13–2.12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SBP <100mmHg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.90 (1.99–4.23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dyspnea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.81 (1.27–2.60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chest pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.52 (0.39–0.71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Syncope \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.58 (0.37–0.92) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ECS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.16 (0.04–0.63) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cancer<a class="elsevierStyleCrossRef" href="#tblfn0025">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.60 (2.68–4.82) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Recent surgery<a class="elsevierStyleCrossRef" href="#tblfn0030">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.39 (0.19–0.81) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Immobilization<a class="elsevierStyleCrossRef" href="#tblfn0035">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.82 (1.33–2.49) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">High risk on simplified PESI<a class="elsevierStyleCrossRef" href="#bib0220">18</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.25 (4.11–12.80) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1501017.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "a" "nota" => "Active or in treatment in the last year." ] 1 => array:3 [ "identificador" => "tblfn0030" "etiqueta" => "b" "nota" => "In the previous month." ] 2 => array:3 [ "identificador" => "tblfn0035" "etiqueta" => "c" "nota" => "Non-surgical patients bedridden for 4 or more days in the month prior to the diagnosis of PE." ] ] ] "descripcion" => array:1 [ "en" => "Univariate Analysis for All-Cause Mortality in PE Patients." ] ] 5 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "ECS, economy class syndrome; HR, heart rate; OR, odds ratio; PESI, Pulmonary Embolism Severity Index; SBP, systolic blood pressures." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Predictive Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Adjusted OR (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age >80 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.42 (1.01–2.00) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.04 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HR ≥110/min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.31 (0.93–1.85) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SBP <100mmHg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.13 (1.43–3.17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ECS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.22 (0.05–0.94) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.04 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cancer<a class="elsevierStyleCrossRef" href="#tblfn0040">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.42 (2.43–4.83) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Recent surgery<a class="elsevierStyleCrossRef" href="#tblfn0045">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.33 (0.16–0.70) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Immobilization<a class="elsevierStyleCrossRef" href="#tblfn0050">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.87 (1.33–2.63) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">High risk on simplified PESI18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.08 (1.63–5.81) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1501016.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0040" "etiqueta" => "a" "nota" => "Active or in treatment in the last year." ] 1 => array:3 [ "identificador" => "tblfn0045" "etiqueta" => "b" "nota" => "In the previous month." ] 2 => array:3 [ "identificador" => "tblfn0050" "etiqueta" => "c" "nota" => "Non-surgical patients bedridden for 4 or more days in the month prior to the diagnosis of PE." ] ] ] "descripcion" => array:1 [ "en" => "Multivariate Analysis for All-Cause Mortality in PE Patients." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib0135" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.Z. 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Original Article

Clinical Characteristics and Prognosis of Pulmonary Embolism Caused by Economy Class Syndrome

Características clínicas y pronóstico de la tromboembolia pulmonar secundaria al síndrome de clase turista

María Abellása, Ana Menéndezb, Raquel Morilloc, Luis Jara-Palomaresd, Deisy Barriosc, Rosa Nietoc, Esther Barberoc, Jesús Correse, Pedro Ruiz-Artachof, David Jiménezc,

Corresponding author

djimenez.hrc@gmail.com

Corresponding author.

a Servicio de Cardiología, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain

b Medicina Familiar y Comunitaria, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain

c Servicio de Neumología, Hospital Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain

d Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Servicio de Neumología, Hospital Universitario Virgen del Rocío, CIBERES, Sevilla, Spain

e Servicio de Urgencias, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain

f Servicio de Urgencias, Hospital Clínico San Carlos, IdISSC, Madrid, Spain

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Pulmonary embolism &#40;PE&#41; is a disease with a wide spectrum of clinical manifestations&#44; prognoses&#44; and treatments&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">1</span></a> Depending on the patient&#39;s hemodynamic status and right ventricular function at the time of diagnosis&#44; the disease is classified as <span class="elsevierStyleItalic">high risk</span> PE &#40;formerly called massive PE&#41;&#44; which is characterized by the presence of arterial hypotension or shock&#44; <span class="elsevierStyleItalic">intermediate risk</span> PE &#40;formerly submassive PE&#41; that occurs in normotensive patients with right ventricular dysfunction and myocardial damage&#44; or <span class="elsevierStyleItalic">low risk</span> PE&#44; in which the patient is hemodynamically stable and right ventricular function is normal&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">2&#8211;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">However&#44; the short-term prognosis of patients with acute symptomatic PE depends not only on the severity of the presentation of the PE&#44; but also on the patient&#39;s baseline characteristics and the factor that triggered the thrombotic event&#46; For example&#44; patients with PE associated with cancer have a significantly poorer prognosis than patients with PE due to medical immobilization&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">5</span></a> while patients with PE due to major surgery have the best short-term prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">6</span></a> Several studies have shown that prolonged air travel &#40;economy class syndrome &#91;ECS&#93;&#41; is a risk factor for acute symptomatic PE&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">7&#8211;9</span></a> However&#44; the clinical presentation and the short-term prognosis of patients with ECS is still poorly defined&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of this study was to analyze the baseline characteristics of a cohort of patients with acute symptomatic PE&#44; stratified according to the causative risk factor &#40;ECS vs others&#41;&#46; We also compared the short-term prognosis of patients with PE due to ECS with that of patients with idiopathic PE&#44; or PE caused by cancer&#44; immobilization&#44; or surgery&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Method</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Design</span><p id="par0020" class="elsevierStylePara elsevierViewall">We conducted an observational&#44; retrospective study to examine the baseline characteristics and short-term prognosis of a cohort of patients with stable and unstable acute symptomatic PE&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Patients and Selection Criteria</span><p id="par0025" class="elsevierStylePara elsevierViewall">All patients with a diagnosis of symptomatic acute PE from the emergency department of the Hospital Ramon y Cajal &#40;Madrid&#44; Spain&#41; between January 2003 and June 2016 were included consecutively&#46; The diagnosis of PE was confirmed by computed tomography &#40;CT&#41; angiography findings of a partial or complete intraluminal defect surrounded by contrast medium or complete occlusion of a pulmonary artery in 2 consecutive CT slices&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">10</span></a> PE was diagnosed by ventilation&#47;perfusion scintigraphy in patients with a high probability of PE according to PIOPED criteria<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">11</span></a> &#40;at least 1 segmental perfusion defect or 2 subsegmental defects with normal ventilation&#41;&#44; or with clinical suspicion of PE&#44; an inconclusive scintigraphy and diagnostic ultrasound of the lower limbs showing incomplete compressibility of the venous lumen as a sign of deep vein thrombosis &#40;DVT&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">12</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Interventions</span><p id="par0030" class="elsevierStylePara elsevierViewall">Patients received low molecular weight heparin &#40;LMWH&#41; at weight-adjusted doses every 12<span class="elsevierStyleHsp" style=""></span>h for at least 5 days&#46; Vitamin K antagonists were started along with LMWH between day 1 and day 3 of treatment&#44; and LMWH was suspended when the international normalized ratio &#40;INR&#41; was stable and greater than 2&#46;0&#46; INR levels were monitored in accordance with the local practices of the center&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Recanalization treatment &#40;thrombolytics&#44; fragmentation or embolectomy&#41; was used in hemodynamically unstable patients at the discretion of the treating physician&#46; In general&#44; mechanical fragmentation and embolectomy were reserved for unstable patients with contraindications for thrombolysis&#46; A vena cava filter was inserted in patients with contraindication for anticoagulation &#40;active bleeding or high risk of bleeding&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Definitions According to Causative Factor</span><p id="par0040" class="elsevierStylePara elsevierViewall">Study patients were classified into one or more of the following groups&#58;ECS&#44; in patients who had made a journey of more than 4<span class="elsevierStyleHsp" style=""></span>h duration in the month before the diagnosis of PE&#44; irrespective of the mode of transport&#46;Cancer&#44; active or in treatment&#44; in the year prior to the diagnosis of PE&#46;Surgery in the month prior to the diagnosis of PE&#46;Immobilization&#44; in non-surgical patients bedridden for 4 or more days in the month prior to the diagnosis of PE&#46;Pregnancy&#44; postpartum period&#44; use of oral contraceptives in the month prior to the diagnosis of PE&#46;Idiopathic&#44; in the absence of any of the above-mentioned triggers&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Study Episodes</span><p id="par0075" class="elsevierStylePara elsevierViewall">The primary endpoint was defined as all-cause mortality in the month prior to diagnosis&#46; Secondary endpoints were death due to the PE itself&#44; objectively confirmed non-fatal thromboembolic relapse&#44; and non-fatal major bleeding in the month following diagnosis&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Diagnostic criteria of non-fatal thrombotic recurrence were the presence of a new intraluminal defect on CT angiogram&#44; or a new ventilation&#47;perfusion defect on lung scintigraphy&#59; new non-compressible venous segment or increase in the diameter of the thrombus by at least 4<span class="elsevierStyleHsp" style=""></span>mm on lower limb ultrasonography&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">13</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Non-fatal major bleeding was defined as bleeding requiring transfusion of at least 2 units of packed red blood cells&#44; bleeding requiring surgery&#44; or brain&#44; retroperitoneal&#44; or joint bleeding&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">14</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical Analysis</span><p id="par0090" class="elsevierStylePara elsevierViewall">Continuous variables were expressed as mean&#177;standard deviation or median &#40;interquartile range&#41;&#44; as appropriate&#44; and were compared with the Student <span class="elsevierStyleItalic">t</span> test or the Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test for asymmetric data&#46; Categorical variables were represented as percentages and compared using the Chi-square test or Fisher&#39;s exact test&#44; if necessary&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Accumulated incidence curves were estimated using the Kaplan&#8211;Meier method and compared using the log rank test&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">15&#44;16</span></a> A multivariate logistic regression model was constructed to evaluate the possible association between ECS and mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">17</span></a> A maximum model of 14 variables selected on the basis of the published experience and expert opinion was developed&#46; Variables were&#58; &#40;a&#41; age&#59; &#40;b&#41; sex&#59; &#40;c&#41; chronic obstructive pulmonary disease &#40;COPD&#41;&#59; &#40;d&#41; congestive heart failure &#40;CHF&#41;&#59; &#40;e&#41; heart rate&#59; &#40;f&#41; systolic blood pressure&#59; &#40;g&#41; dyspnea&#59; &#40;h&#41; chest pain&#59; &#40;i&#41; syncope&#59; &#40;j&#41; ECS&#59; &#40;k&#41; cancer&#59; &#40;l&#41; recent surgery&#59; &#40;m&#41; immobilization&#44; and &#40;n&#41; simplified Pulmonary Embolism Severity Index &#40;PESI&#41; scale&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">18</span></a> The analysis was constructed on the basis of the maximum model and by backward elimination of variables&#46; Confounding variables &#40;i&#46;e&#46;&#44; the coefficient of the variable evaluated was modified by more than 10&#37; when the confounding variable was eliminated from the model&#41; of the effect of ECS on the primary endpoint were maintained in the model&#46; Odds ratios &#40;OR&#41; and corresponding 95&#37; confidence intervals &#40;CI&#41; were calculated&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">SPSS software &#40;version 19&#46;0&#44; SPSS Inc&#46;&#44; Chicago&#44; Illinois&#44; USA&#41; was used for the statistical analysis&#46; Results with a 2-tailed value of <span class="elsevierStyleItalic">P</span>&#60;&#46;05 were considered statistically significant&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Patients</span><p id="par0105" class="elsevierStylePara elsevierViewall">During the study period&#44; 12<span class="elsevierStyleHsp" style=""></span>629 patients with suspected acute symptomatic PE were evaluated and diagnosis was confirmed in 2445 &#40;19&#46;4&#37;&#41;&#46; Of these&#44; 113 were lost to follow-up&#44; so the final sample consisted of 2333 patients &#40;1089 men and 1244 women&#41;&#44; 95&#37; of the population evaluated &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; No statistically significant differences were found between the baseline variables of the patients who were included and those who were excluded&#46; Approximately 70&#37; of patients &#40;1659&#47;2333&#41; were diagnosed by chest CT angiogram&#44; 744 &#40;32&#37;&#41; by high probability ventilation&#47;perfusion scintigraphy&#44; while 76 &#40;3&#37;&#41; had negative chest studies and DVT confirmed by ultrasound of the lower limbs&#46; Some patients had several simultaneous positive diagnostic tests&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Study patient characteristics are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The number of patients treated with inferior vena cava filters was low &#40;2&#46;2&#37;&#59; 52 of 2333 patients&#41;&#46; Four percent &#40;103 of 2333 patients&#41; were treated with thrombolytics&#46; Fewer patients in the ECS group were men &#40;34&#37; versus 47&#37;&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;01&#41;&#44; and ECS patients were younger &#40;55&#46;8&#177;14&#46;2 vs 69&#46;6&#177;16&#46;5&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41; and had less COPD &#40;0&#37; vs 8&#46;1&#37;&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#44; heart failure &#40;0&#46;8&#37; vs 6&#46;0&#37;&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;01&#41;&#44; cancer &#40;4&#46;8&#37; vs 21&#37;&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#44; and history of recent hemorrhage &#40;0&#37; vs 3&#46;4&#37;&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;03&#41; A higher proportion of patients with ECS was classified as low risk according to the simplified PESI scale &#40;45&#37; vs 29&#37;&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#46; PE was more severe in patients with ECS&#44; who presented more frequently with syncope &#40;48&#37; versus 14&#37;&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#44; tachycardia &#40;37&#37; vs 21&#37;&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#44; right ventricular dysfunction &#40;31&#37; vs 19&#37;&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;01&#41;&#44; and myocardial damage &#40;57&#37; vs 28&#37;&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41; than patients with idiopathic PE or PE due to other etiologies&#46; More patients with ECS had residual DVT &#40;45&#37; vs 57&#37;&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;02&#41;&#46; With regard to treatment&#44; more patients with ECS received thrombolytic treatment &#40;9&#46;8&#37; vs 4&#46;1&#37;&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;01&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Of the 2333 patients&#44; 213 &#40;9&#46;1&#37;&#59; 95&#37; CI&#58; 8&#46;0&#8211;10&#46;4&#41; died during the first 30 days of follow-up &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; Seventy-six patients &#40;36&#37;&#41; died due to their PE&#44; 59 &#40;28&#37;&#41; due to cancer&#44; 25 &#40;12&#37;&#41; due to infection&#44; 10 &#40;4&#46;7&#37;&#41; due to heart failure&#44; 8 &#40;3&#46;8&#37;&#41; due to bleeding&#44; and 35 &#40;16&#37;&#41; due to other causes&#46; Seventy-five patients presented a secondary event&#58; 21 had an objectively confirmed thrombotic recurrence&#44; 50 patients had non-fatal major bleeding&#44; and 4 presented simultaneous bleeding and recurrence&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Patients with ECS had a significantly lower risk of all-cause death than patients with idiopathic PE or PE from other causes &#40;log rank test&#44; <span class="elsevierStyleItalic">P</span>&#60;&#46;01&#59; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Mortality due to the PE itself in the first month of follow-up was similar in ECS and non-ECS patients &#40;log rank test&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;11&#41;&#46; None of the ECS patients had thromboembolic recurrence&#44; and only 1 &#40;0&#46;8&#37;&#41; had non-fatal major bleeding in the first 30 days of follow-up&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">In the univariate analysis&#44; age &#62;80 years &#40;OR&#58; 1&#46;82&#59; 95&#37; CI&#58; 1&#46;36&#8211;2&#46;44&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#44; some comorbidities&#44; including COPD &#40;OR&#58; 2&#46;15&#59; 95&#37; CI&#58; 1&#46;41&#8211;3&#46;28&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#44; heart failure &#40;OR&#58; 2&#46;59&#59; 95&#37; CI&#58; 1&#46;64&#8211;4&#46;07&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#44; cancer &#40;OR&#58; 3&#46;60&#59; 95&#37; CI&#58; 2&#46;68&#8211;4&#46;82&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#44; together with medical immobilization &#40;OR&#58; 1&#46;82&#59; 95&#37; CI&#58; 1&#46;33&#8211;2&#46;49&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#44; clinical presentation &#91;tachycardia &#40;OR&#58; 1&#46;55&#59; 95&#37; CI&#58; 1&#46;13&#8211;2&#46;12&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;01&#41; and hypotension &#40;OR&#58; 2&#46;90&#59; 95&#37; CI&#58; 1&#46;99&#8211;4&#46;23&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#93;&#44; and high risk on the simplified PESI scale &#40;OR&#58; 7&#46;25&#59; 95&#37; CI&#58; 4&#46;11&#8211;12&#46;80&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41; significantly increased the risk of all-cause death in the 30 days after PE diagnosis &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; In contrast&#44; a history of recent surgery &#40;OR&#58; 0&#46;39&#59; &#40;95&#37; CI&#58; 0&#46;19&#8211;0&#46;81&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;01&#41; and ECS &#40;OR&#58; 0&#46;16&#59; 95&#37; CI&#58; 0&#46;04&#8211;0&#46;63&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;01&#41; were associated with a statistically significant reduction in the risk of death&#46; In the multivariate analysis&#44; ECS was independently associated with all-cause death during the first 30 days of follow-up &#40;OR&#58; 0&#46;22&#59; 95&#37; CI&#58; 0&#46;05&#8211;0&#46;94&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;04&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46; ECS was not independently associated with death due to the PE itself during the first 30 days of follow-up &#40;OR&#58; 0&#46;37&#59; 95&#37; CI&#58; 0&#46;05&#8211;2&#46;77&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;33&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0130" class="elsevierStylePara elsevierViewall">This study analyzed the clinical presentation and short-term prognosis of ECS in a large series of patients with acute symptomatic PE&#46; Our results indicate that PE in patients with ECS more frequently causes right ventricular dysfunction and myocardial damage than idiopathic PE or PE triggered by other causes&#46; However&#44; the short-term prognosis of these patients is excellent&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">We found that&#44; while patients with PE caused by ECS are younger and have less comorbidity &#40;e&#46;g&#46;&#44; COPD&#44; heart failure&#41; than patients with idiopathic PE or PE due to other causes&#44; its form of presentation is more severe&#44; and it began more frequently with syncope&#44; tachycardia&#44; and hypotension&#44; all factors for poor prognosis in the acute phase of the PE&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">19&#8211;22</span></a> Interestingly&#44; right ventricular dysfunction and myocardial necrosis were significantly more frequent in these patients&#46; These results are similar to those of a previous study that evaluated the form of presentation of patients with ECS&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">23</span></a> The reasons why these patients present this way remain unclear&#44; but some mechanisms may be responsible&#46; Hypoxia in the aircraft cabin increases pulmonary arterial pressure and could worsen right ventricular function&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">24</span></a> Residual DVT was less frequent in patients with ECS than in patients with idiopathic PE or PE triggered by other causes&#44; perhaps because in these patients the entire clot formed in the lower limbs breaks free&#44; causing PE with a larger clot burden&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Despite their more severe PE&#44; the short-term prognosis of these patients is excellent&#44; and significantly better than that of patients with PE due to cancer or immobilization&#46; This can be explained by the fact that while early death &#40;in the initial days&#41; among patients with PE is a result of right ventricular failure&#44; late mortality is the result of patient comorbidity&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">25</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">What is the clinical significance of this study&#63; Clinical practice guidelines advise against the use of fibrinolytic treatment in patients with intermediate risk PE&#46; The PEITHO study analyzed the efficacy and safety of treatment with tenecteplase in normotensive patients with right ventricular dysfunction and myocardial damage&#46; Although fibrinolytics significantly reduced the hemodynamic collapse of these patients&#44; mortality was not affected&#44; and severe bleeds were significantly more frequent in those who received fibrinolysis&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">26</span></a> Our results support this recommendation in the subgroup of patients with PE due to ECS&#46; Although this presentation is more serious &#40;e&#46;g&#46;&#44; intermediate-high risk PE&#41;&#44; prognosis is excellent when conventional anticoagulation is administered&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Our study has some limitations&#46; Firstly&#44; as this is an analysis of a historical cohort composed of patients from a single hospital&#44; it is subject to the biases inherent to this type of study and results are not generalizable&#46; However&#44; it represents an unselected population of PE patients seen in routine clinical practice in our setting&#44; so it may be considered an ideal series for evaluating the form of presentation and prognosis of patients with ECS&#46; Secondly&#44; we could not measure the clot burden of our patients&#44; so we cannot establish an association between the degree of pulmonary artery obstruction and the presence or absence of right ventricular dysfunction&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">In conclusion&#44; our results show that patients with PE caused by ECS have less comorbidity than patients with idiopathic PE or PE due to other causes&#46; Although these patients more frequently present with high-intermediate risk PE&#44; their short-term prognosis is excellent with conventional anticoagulation&#46; Well-designed studies are needed to understand why these patients more often present right ventricular dysfunction and myocardial damage in the acute phase of the PE&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflict of Interest</span><p id="par0160" class="elsevierStylePara elsevierViewall">The authors state that they have no conflict of interest&#46;</p></span></span>"
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    "fechaRecibido" => "2016-12-05"
    "fechaAceptado" => "2017-02-18"
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            0 => "Pulmonary embolism"
            1 => "Economy-class syndrome"
            2 => "Prognosis"
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          "palabras" => array:3 [
            0 => "Tromboembolia de pulm&#243;n"
            1 => "S&#237;ndrome de clase turista"
            2 => "Pron&#243;stico"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical presentation and short-term prognosis of patients with travel-associated acute pulmonary embolism &#40;PE&#41; &#40;i&#46;e&#46;&#44; economy class syndrome &#91;ECS&#93;&#41; is not well understood&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">In this retrospective cohort study of patients with acute PE identified from a single center registry&#44; we assessed the clinical presentation and the association between ECS and the outcomes of all-cause mortality&#44; PE-related mortality&#44; nonfatal venous thromboembolism and nonfatal major bleeding rates through 30<span class="elsevierStyleHsp" style=""></span>days after initiation of PE treatment&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Of the 2333 patients with acute symptomatic PE&#44; 124 &#40;5&#46;3&#37;&#59; 95&#37; confidence interval&#44; 4&#46;4&#37;&#8211;6&#46;3&#37;&#41; had ECS&#46; Patients with ECS were younger and had fewer comorbid diseases &#40;recent bleeding&#44; chronic obstructive pulmonary disease&#44; congestive heart failure&#41;&#44; but they presented with more signs of clinical severity &#40;syncope &#91;48&#37; vs 14&#37;&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#93;&#44; tachycardia &#91;37&#37; vs 21&#37;&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#93;&#44; right ventricular dysfunction &#91;31&#37; vs 19&#37;&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;01&#93; and myocardial injury &#91;57&#37; vs 28&#37;&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#93;&#41; compared to those without ECS&#46; Regression analyses showed a significantly lower risk of all-cause mortality for patients with ECS compared to patients without ECS &#40;1&#46;6&#37; vs 9&#46;6&#37;&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;01&#41;&#46; We did not detect a difference in PE-related mortality at 30<span class="elsevierStyleHsp" style=""></span>days between those with and those without ECS &#40;0&#46;8&#37; vs 3&#46;1&#37;&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;18&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">PE patients with ECS are younger and have fewer comorbid diseases compared to those without ECS&#46; Though they present with more signs of clinical severity&#44; their short-term prognosis is excellent&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">No se conocen suficientemente las caracter&#237;sticas cl&#237;nicas y el pron&#243;stico de los pacientes con tromboembolia de pulm&#243;n &#40;TEP&#41; aguda sintom&#225;tica asociada a los viajes prolongados &#40;s&#237;ndrome de clase turista &#91;SCT&#93;&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se analizaron retrospectivamente las caracter&#237;sticas basales de los pacientes con TEP aguda y se estratificaron seg&#250;n el factor de riesgo desencadenante&#46; Se determinaron la mortalidad por todas las causas&#44; la mortalidad por la propia TEP&#44; las recurrencias tromb&#243;ticas no fatales y los sangrados mayores no fatales durante los primeros 30<span class="elsevierStyleHsp" style=""></span>d&#237;as de seguimiento&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">De los 2&#46;333 pacientes incluidos&#44; un total de 124 &#40;5&#44;3&#37;&#59; intervalo de confianza del 95&#37;&#58; 4&#44;4&#8211;6&#44;3&#41; fueron diagnosticados de TEP secundaria a SCT&#46; Estos pacientes fueron m&#225;s j&#243;venes&#44; presentaron menos frecuentemente comorbilidad y m&#225;s frecuentemente s&#237;ncope &#40;48&#37; vs 14&#37;&#59; p&#60;0&#44;001&#41;&#44; taquicardia &#40;37&#37; vs 21&#37;&#59; p&#60;0&#44;001&#41;&#44; disfunci&#243;n de ventr&#237;culo derecho &#40;VD&#41; &#40;31&#37; vs 19&#37;&#59; p&#60;0&#44;01&#41; y da&#241;o mioc&#225;rdico &#40;57&#37; vs 28&#37;&#59; p&#60;0&#44;001&#41; que los dem&#225;s pacientes con TEP&#46; La mortalidad por todas las causas a 30<span class="elsevierStyleHsp" style=""></span>d&#237;as fue significativamente menor para los pacientes con TEP secundaria a SCT &#40;1&#44;6&#37; vs 9&#44;6&#37;&#59; p&#60;0&#44;01&#41;&#46; La mortalidad a 30<span class="elsevierStyleHsp" style=""></span>d&#237;as por TEP no fue diferente entre los dos grupos de pacientes &#40;0&#44;8&#37; vs 3&#44;1&#37;&#59; p&#61;0&#44;18&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Los pacientes con TEP y SCT son m&#225;s j&#243;venes y tienen menos comorbilidad que los dem&#225;s pacientes con TEP&#46; Aunque se presentan m&#225;s frecuentemente con disfunci&#243;n de VD y da&#241;o mioc&#225;rdico&#44; el pron&#243;stico a corto plazo es excelente&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0055">Please cite this article as&#58; Abell&#225;s M&#44; Men&#233;ndez A&#44; Morillo R&#44; Jara-Palomares L&#44; Barrios D&#44; Nieto R&#44; et al&#46; Caracter&#237;sticas cl&#237;nicas y pron&#243;stico de la tromboembolia pulmonar secundaria al s&#237;ndrome de clase turista&#46; Arch Bronconeumol&#46; 2017&#59;53&#58;495&#8211;500&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Survival curve for the primary endpoint&#46; Log rank test&#44; <span class="elsevierStyleItalic">P</span>&#60;&#46;01&#46;</p>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">BNP&#44; brain natriuretic peptide&#59; cTnI&#44; cardiac troponin <span class="elsevierStyleSmallCaps">I</span>&#59; COPD&#44; chronic obstructive pulmonary disease&#59; DVT&#44; deep vein thrombosis&#59; ECS&#44; economy class syndrome&#59; PESI&#44; Pulmonary Embolism Severity Index&#59; SBP&#44; systolic blood pressure&#46;</p>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">All<br><span class="elsevierStyleItalic">n</span>&#61;2333<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Idiopathic<br><span class="elsevierStyleItalic">n</span>&#61;982&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ECS<br><span class="elsevierStyleItalic">n</span>&#61;124&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cancer<br><span class="elsevierStyleItalic">n</span>&#61;462&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Immobilization<br><span class="elsevierStyleItalic">n</span>&#61;477&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Surgery<br><span class="elsevierStyleItalic">n</span>&#61;200&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Clinical characteristics&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Age&#44; years&#44; median &#40;25&#8211;75 percentiles&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74 &#40;59&#8211;81&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75 &#40;63&#8211;82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54 &#40;44&#8211;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72 &#40;61&#8211;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79 &#40;68&#8211;86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68 &#40;52&#8211;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Age &#62;80 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">624 &#40;27&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">285 &#40;29&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79 &#40;17&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">210 &#40;44&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35 &#40;18&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1089 &#40;47&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">510 &#40;52&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42 &#40;34&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">252 &#40;55&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">178 &#40;37&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">88 &#40;44&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Comorbidity&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>History of severe bleeding<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74 &#40;3&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19 &#40;1&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;2&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42 &#40;8&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;5&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>COPD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">180 &#40;7&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80 &#40;8&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32 &#40;6&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53 &#40;11&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;4&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Heart failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">134 &#40;5&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62 &#40;6&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;2&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48 &#40;10&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;2&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Signs and symptoms at diagnosis</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Syncope&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">372 &#40;16&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">156 &#40;16&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60 &#40;48&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56 &#40;12&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74 &#40;16&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;10&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Chest pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1019 &#40;44&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">450 &#40;46&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52 &#40;42&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">174 &#40;38&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">158 &#40;33&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">93 &#40;47&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Dyspnea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1681 &#40;72&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">706 &#40;72&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78 &#40;63&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">329 &#40;71&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">363 &#40;76&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">147 &#40;74&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>DVT symptoms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">545 &#40;23&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">239 &#40;24&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;19&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">108 &#40;23&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92 &#40;19&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34 &#40;17&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Heart rate &#8805;110&#47;min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">498 &#40;21&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">206 &#40;21&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46 &#40;37&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">93 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">115 &#40;24&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42 &#40;21&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hemoglobin saturation &#40;SaO<span class="elsevierStyleInf">2</span>&#41; &#60;90&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">643 &#40;28&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">290 &#40;30&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28 &#40;23&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">207 &#40;45&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">167 &#40;35&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53 &#40;27&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>SBP &#60;90<span class="elsevierStyleHsp" style=""></span>mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">94 &#40;4&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;3&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;3&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;5&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;6&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;4&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Simplified PESI &#40;18&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Low risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">693 &#40;30&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">356 &#40;36&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56 &#40;45&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69 &#40;34&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>High risk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1640 &#40;70&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">626 &#40;64&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68 &#40;55&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">462 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">380 &#40;80&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">131 &#40;66&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Clinical laboratory tests</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hemoglobin&#44; g&#47;dl&#44; median &#40;percentiles 25&#8211;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;3 &#40;12&#46;0&#8211;14&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;9 &#40;12&#46;7&#8211;15&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;6 &#40;12&#46;6&#8211;14&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;4 &#40;10&#46;8&#8211;13&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;9 &#40;11&#46;9&#8211;13&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;3 &#40;10&#46;7&#8211;13&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Creatinine &#62;2<span class="elsevierStyleHsp" style=""></span>mg&#47;dl &#40;<span class="elsevierStyleItalic">n</span>&#61;2306&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89 &#40;3&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49 &#40;5&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;1&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;2&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28 &#40;5&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;2&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Ultrasound and biomarkers&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Concomitant diseases &#40;<span class="elsevierStyleItalic">n</span>&#61;1784&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1010 &#40;57&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">422 &#40;43&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43 &#40;35&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">218 &#40;47&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">207 &#40;43&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72 &#40;36&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Right ventricular dysfunction &#40;<span class="elsevierStyleItalic">n</span>&#61;1275&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">458 &#40;36&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">228 &#40;23&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38 &#40;31&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58 &#40;13&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89 &#40;19&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32 &#40;16&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>BNP &#62;200<span class="elsevierStyleHsp" style=""></span>pg&#47;dl &#40;<span class="elsevierStyleItalic">n</span>&#61;917&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">446 &#40;49&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">221 &#40;23&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;15&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70 &#40;15&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">110 &#40;23&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;16&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Treatment&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Thrombolysis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">103 &#40;4&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51 &#40;5&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;9&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;1&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19 &#40;4&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Inferior vena cava filter&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52 &#40;2&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;2&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;2&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;3&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;3&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Some patients presented several risk factors simultaneously&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Since patients with PE due to hormone replacement therapy&#44; use of oral contraceptives&#44; pregnancy&#44; postpartum&#44; or hereditary thrombophilia were not included in the analysis&#44; the sum of patients of the columns is not 2333&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">In the previous month&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Baseline Characteristics and Treatment of Study Subjects&#46;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></p>"
        ]
      ]
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        "tipo" => "MULTIMEDIATABLA"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">All<br><span class="elsevierStyleItalic">n</span>&#61;2333&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Idiopathic<br><span class="elsevierStyleItalic">n</span>&#61;982&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ECS<br><span class="elsevierStyleItalic">n</span>&#61;124&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cancer<br><span class="elsevierStyleItalic">n</span>&#61;462&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Immobilization<br><span class="elsevierStyleItalic">n</span>&#61;477&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Surgery<br><span class="elsevierStyleItalic">n</span>&#61;200&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">All-cause death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">213 &#40;9&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54 &#40;5&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;1&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92 &#40;19&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65 &#40;13&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;4&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Death due to PE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76 &#40;3&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19 &#40;1&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;5&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;6&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;1&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Non-fatal recurrence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;1&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;0&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;1&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;1&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;3&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Non-fatal bleeding&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">54 &#40;2&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23 &#40;2&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;2&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;2&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;2&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Some patients presented several risk factors simultaneously&#46;</p>"
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          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Mortality and Non-Fatal Adverse Events During the First 30 Days of Follow-Up&#46;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a></p>"
        ]
      ]
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        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
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            "identificador" => "at3"
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">CHF&#44; congestive heart failure&#59; COPD&#44; chronic obstructive pulmonary disease&#59; ECS&#44; economy class syndrome&#59; HR&#44; heart rate&#59; OR&#44; odds ratio&#59; PESI&#44; Pulmonary Embolism Severity Index&#59; SBP&#44; systolic blood pressure&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Predictive Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Unadjusted OR &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age &#62;80 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;82 &#40;1&#46;36&#8211;2&#46;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Male sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;17 &#40;0&#46;88&#8211;1&#46;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">COPD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;15 &#40;1&#46;41&#8211;3&#46;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CHF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;59 &#40;1&#46;64&#8211;4&#46;07&#41;&nbsp;\t\t\t\t\t\t\n
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                    0 => array:2 [
                      "titulo" => "Acute pulmonary embolism&#58; clinical outcomes in the International Cooperative Pulmonary Embolism Registry"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;Z&#46; Goldhaber"
                            1 => "L&#46; Visani"
                            2 => "M&#46; de Rosa"
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                        ]
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                    ]
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                    0 => array:1 [
                      "Revista" => array:6 [
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                        "volumen" => "353"
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                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10227218"
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                    0 => array:2 [
                      "titulo" => "Risk stratification of normotensive patients with acute pulmonary embolism"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46; Jim&#233;nez"
                            1 => "D&#46; Aujesky"
                            2 => "R&#46;D&#46; Yusen"
                          ]
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                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2141.2010.08406.x"
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                        "tituloSerie" => "Br J Haematol"
                        "fecha" => "2010"
                        "volumen" => "151"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20955409"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Authors&#47;Task Force Members&#46; 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism&#58; The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology &#40;ESC&#41; Endorsed by the European Respiratory Society &#40;ERS&#41;"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;V&#46; Konstantinides"
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                            2 => "G&#46; Agnelli"
                            3 => "N&#46; Danchin"
                            4 => "D&#46; Fitzmaurice"
                            5 => "N&#46; Gali&#232;"
                          ]
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                      ]
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                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/ehu283"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2014"
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                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25173341"
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                    0 => array:2 [
                      "titulo" => "Antithrombotic therapy for VTE disease&#58; CHEST guideline and Expert Panel Report"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Kearon"
                            1 => "E&#46;A&#46; Akl"
                            2 => "J&#46; Ornelas"
                            3 => "A&#46; Blaivas"
                            4 => "D&#46; Jimenez"
                            5 => "H&#46; Bounameaux"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.chest.2015.11.026"
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                        "fecha" => "2016"
                        "volumen" => "149"
                        "paginaInicial" => "315"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26867832"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thromboembolism"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Prandoni"
                            1 => "A&#46;W&#46; Lensing"
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                            3 => "E&#46; Bernardi"
                            4 => "P&#46; Simioni"
                            5 => "B&#46; Girolami"
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                    0 => array:2 [
                      "doi" => "10.1182/blood-2002-01-0108"
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                        "tituloSerie" => "Blood"
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                        "volumen" => "100"
                        "paginaInicial" => "3484"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12393647"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The outcome after treatment of venous thromboembolism is different in surgical and acutely ill medical patients&#46; Findings form the RIETE registry"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "A&#46;K&#46; Kakkar"
                            2 => "J&#46;A&#46; Caprini"
                            3 => "R&#46; Barba"
                            4 => "F&#46; Uresandi"
                            5 => "R&#46; Valle"
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Article information

ISSN: 15792129
Original language: English

DOI:10.1016/j.arbr.2017.07.006

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	5	2	7
2024 October	51	15	66
2024 September	59	15	74
2024 August	72	38	110
2024 July	58	25	83
2024 June	61	25	86
2024 May	96	40	136
2024 April	52	30	82
2024 March	49	29	78
2024 February	35	28	63
2023 March	17	4	21
2023 February	52	25	77
2023 January	30	34	64
2022 December	98	36	134
2022 November	108	24	132
2022 October	118	31	149
2022 September	37	33	70
2022 August	42	44	86
2022 July	45	57	102
2022 June	35	45	80
2022 May	32	42	74
2022 April	46	43	89
2022 March	42	39	81
2022 February	35	36	71
2022 January	66	44	110
2021 December	159	40	199
2021 November	162	38	200
2021 October	51	62	113
2021 September	35	45	80
2021 August	35	48	83
2021 July	29	35	64
2021 June	54	56	110
2021 May	34	50	84
2021 April	114	106	220
2021 March	63	39	102
2021 February	44	31	75
2021 January	41	31	72
2020 December	54	31	85
2020 November	29	16	45
2020 October	49	22	71
2020 September	43	21	64
2020 August	33	14	47
2020 July	19	25	44
2020 June	26	12	38
2020 May	42	15	57
2020 April	30	25	55
2020 March	31	17	48
2020 February	42	22	64
2020 January	50	20	70
2019 December	49	32	81
2019 November	36	25	61
2019 October	39	27	66
2019 September	79	16	95
2019 August	72	24	96
2019 July	90	27	117
2019 June	110	22	132
2019 May	93	19	112
2019 April	66	43	109
2019 March	63	31	94
2019 February	57	31	88
2019 January	64	26	90
2018 December	65	25	90
2018 November	98	37	135
2018 October	121	27	148
2018 September	53	13	66
2018 May	16	2	18
2018 April	21	9	30
2018 March	23	11	34
2018 February	26	13	39
2018 January	22	15	37
2017 December	44	20	64
2017 October	0	1	1
2017 August	0	7	7

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