BACKGROUND Isolated PE is associated with a higher burden of atherosclerotic disease than other manifestations of venous thromboembolism (VTE). RESEARCH QUESTION We hypothesized that the presence of isolated PE may signal a chronically elevated risk of arterial thrombotic disease. STUDY DESIGN AND METHODS Data from the VTEval Study, a prospective cohort study enrolling individuals with clinical suspicion and imaging-based diagnosis or exclusion of VTE, were analyzed. Patients with PE received whole-leg ultrasonography to assess presence of deep vein thrombosis (DVT). Regularized logistic regression identified features that discriminate between isolated PE and other VTE phenotypes at clinical presentation. Survival analyses were performed to evaluate the crude and adjusted 3-year risks of arterial thrombotic disease, recurrent VTE, and death. RESULTS The sample comprised 510 patients. Isolated PE patients (n=63) had a distinct clinical profile from patients with other VTE phenotypes (n=447). Chronic obstructive pulmonary disease (COPD), peripheral artery disease, atrial fibrillation and coronary artery disease were significantly more prevalent among patients with isolated PE. Isolated PE patients had significantly higher risk (incidence rate ratio vs DVT-associated PE: 3.7 [95% confidence interval: 1.3-10.8], p=0.009; vs isolated DVT: 4.8 [1.7-14.3], p=0.001) of arterial thrombotic events (i.e. myocardial infarction, stroke/transient ischemic attack). After adjustment for clinical profile and medication intake, the risk of arterial thrombotic events for patients with isolated PE remained quadruple that of other VTE phenotypes (hazard ratio, HR: 4.1 [1.4-11.7], p=0.009). INTERPRETATION Patients with isolated PE are at higher risk for arterial thrombosis, and may require screening for arterial disease and development of novel therapeutic strategies.

中文翻译：

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孤立的肺栓塞与动脉血栓性疾病的高风险相关——来自 VTEval 研究的结果

背景与静脉血栓栓塞 (VTE) 的其他表现相比，孤立的 PE 与动脉粥样硬化疾病的负担更高。研究问题 我们假设孤立性 PE 的存在可能预示着动脉血栓形成疾病的风险长期升高。研究设计和方法 对来自 VTEval 研究的数据进行了分析，该研究是一项前瞻性队列研究，招募具有临床怀疑和基于影像学诊断或排除 VTE 的个体。PE 患者接受全腿超声检查以评估深静脉血栓形成 (DVT) 的存在。正则化逻辑回归确定了在临床表现时区分孤立性 PE 和其他 VTE 表型的特征。进行生存分析以评估动脉血栓形成疾病、复发性 VTE 和死亡的粗略和调整后的 3 年风险。结果 样本包括 510 名患者。孤立的 PE 患者 (n=63) 与具有其他 VTE 表型的患者 (n=447) 具有不同的临床特征。慢性阻塞性肺疾病 (COPD)、外周动脉疾病、心房颤动和冠状动脉疾病在孤立性 PE 患者中更为普遍。孤立的 PE 患者有显着更高的动脉风险（发生率比与 DVT 相关的 PE：3.7 [95% 置信区间：1.3-10.8]，p=0.009；与孤立的 DVT：4.8 [1.7-14.3]，p=0.001）血栓事件（即心肌梗塞、中风/短暂性脑缺血发作）。在调整临床特征和药物摄入量后，孤立性 PE 患者发生动脉血栓事件的风险仍然是其他 VTE 表型的四倍（风险比，HR：4.1 [1.4-11.7]，p=0.009）。