Relative risk of pulmonary embolism in the very elderly compared with the elderly

Josef Yayan

Department of Internal Medicine, University Hospital of Saarland, Homburg/Saar, Germany

Background: Pulmonary embolism (PE) can be an acute, life-threatening emergency, and studies suggest that advanced age is a risk factor for this condition. However, the literature is scarce regarding PE in patients above the age of 90 years. This study examined the relative risk for PE in the very elderly (>90 years) compared with that in the elderly (80–89 years).
Methods: A retrospective study was performed examining very elderly patients diagnosed with PE in the Department of Internal Medicine at the University Hospital Homburg/Saar in Germany between 2004 and 2012. Elderly patients (aged 80–89 years) diagnosed with PE served as controls. PE was confirmed by contrast-enhanced chest computed tomography or ventilation perfusion scintigraphy in both groups. A total of 2230 patients were examined for PE in this study. Of these, 15 (0.67%) in the study group and 197 (8.83%) in the control group underwent further evaluation for PE.
Results: After performing a radiological examination, 11 (73.3%, including six [54.55%] women) of the 15 study patients (mean age 91.6 ± 1.67 years) and 148 (75.1%, including 93 [62.84%] women) of the 197 controls (mean age 84.0 ± 2.59 years) were confirmed to have PE. There was a significantly lower proportion of the very elderly enrolled in the study (P < 0.001). There were no significant differences in clinical presentation, cardiovascular risk factors, electrocardiograms, blood gas analyses, radiological diagnoses, or acute comorbidities between the groups. However, the very elderly were more likely to experience minor bleeding in the extremities (P = 0.016) and to have more chronic diseases (P < 0.001). An increased relative risk of PE was not detected in the very elderly (relative risk 0.98, P = 0.88). Furthermore, d-dimer, troponin T, and high-sensitive troponin T levels had limited predictive value for PE in the very elderly. There were no significant differences in the number of hospital admissions, intensive care or ward treatments, or duration of hospitalization.
Conclusion: The relative risk for PE in the very elderly is not higher than that in the elderly.

Keywords: embolism, aging, electrocardiography, morbidity, risk factors