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. 2021 Oct 26:8:721294.
doi: 10.3389/fmed.2021.721294. eCollection 2021.

Higher Incidence of Chronic Thromboembolic Pulmonary Hypertension After Acute Pulmonary Embolism in Asians Than in Europeans: A Meta-Analysis

Wenyi Pang  1   2   3   4   5 , Zhu Zhang  1   2   3   4 , Zenghui Wang  1   2   3   4   5 , Kaiyuan Zhen  1   2   3   4 , Meng Zhang  1   2   3   4 , Yunxia Zhang  1   2   3   4 , Qian Gao  1   2   3   4 , Shuai Zhang  1   2   3   4 , Xincao Tao  1   2   3   4 , Jun Wan  1   2   3   4   6 , Wanmu Xie  1   2   3   4   6 , Zhenguo Zhai  1   2   3   4   5   6
Affiliations

Higher Incidence of Chronic Thromboembolic Pulmonary Hypertension After Acute Pulmonary Embolism in Asians Than in Europeans: A Meta-Analysis

Wenyi Pang et al. Front Med (Lausanne). .

Abstract

Aim: To summarize the incidence of right heart catheter diagnosed chronic thromboembolic pulmonary hypertension (CTEPH) after acute pulmonary embolism (PE) in a meta-analysis. Methods: Cohort studies reporting the incidence of CTEPH after acute PE were identified via search of Medline, Embase, China National Knowledge Infrastructure and WanFang databases. Results: Twenty-two cohort studies with 5,834 acute PE patients were included. Pooled results showed that the overall incidence of CTEPH was 2.82% (95% CI: 2.11-3.53%). Subgroup analyses showed higher incidence of CTEPH in Asians than Europeans (5.08 vs. 1.96%, p = 0.01), in retrospective cohorts than prospective cohorts (4.75 vs. 2.47%, p = 0.02), and in studies with smaller sample size than those with larger sample size (4.57 vs. 1.71%, p < 0.001). Stratified analyses showed previous venous thromboembolic events and unprovoked PE were both significantly associated with increased risk of CTEPH (OR = 2.57 and 2.71, respectively; both p < 0.01). Conclusions: The incidence of CTEPH after acute PE is ~3% and the incidence is higher in Asians than Europeans. Efforts should be made for the early diagnosis and treatment of CTEPH in PE patients, particularly for high-risk population.

Keywords: chronic thromboembolic pulmonary hypertension; cohort study; incidence; meta-analysis; pulmonary embolism.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of literature search.
Figure 2
Figure 2
Forest plots for the meta-analysis of the incidence of CTEPH in patients after acute PE.
Figure 3
Figure 3
Forest plots for the meta-analysis evaluating the risk of CTEPH in patients with and without previous VTE, and in patients with provoked and unprovoked PE; (A) comparing risk of CTEPH in patients with and without previous VTE; and (B) comparing risk of CTEPH in patients with unprovoked and provoked PE.
Figure 4
Figure 4
Funnel plots for the meta-analysis evaluating the risk of CTEPH in patients with and without previous VTE, and in patients with provoked and unprovoked PE; (A) comparing risk of CTEPH in patients with and without previous VTE; and (B) comparing risk of CTEPH in patients with unprovoked and provoked PE.
See this image and copyright information in PMC

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