Prognostische Bedeutung von Thoraxschmerzen bei akuter Lungenarterienembolie

Acute pulmonary embolism (PE) is a common and potentially life-threatening cardiovascular disease associated with significant morbidity and mortality. Chest pain is a frequent symptom in patients with acute PE. Previous studies suggested a possible association between chest pain and improved clinical outcomes; however, the prognostic relevance and underlying mechanisms remain insufficiently understood. This study aimed to evaluate the prognostic significance of chest pain in patients with acute pulmonary embolism and to investigate whether differences in initial clinical management may contribute to potential outcome differences. Data were analyzed from the Pulmonary Embolism Registry Göttingen, a prospective single-center cohort study. Patients with confirmed symptomatic acute PE between 2008 and 2019 were included. The primary endpoint was the occurrence of PE-related complications during hospitalization. The secondary endpoint was all-cause in-hospital mortality. A total of 858 patients were included in the analysis. Chest pain was present in approximately half of the patients at diagnosis. Patients presenting with chest pain were younger and had fewer comorbidities. Chest pain was associated with significantly lower rates of PE-related complications and lower in-hospital mortality. Multivariable analyses confirmed the independent association between chest pain and favorable in-hospital outcome. Differences in emergency management, including higher rates of prehospital medical contact and earlier anticoagulation, did not explain this association. Chest pain in patients with acute pulmonary embolism is associated with a more favorable in-hospital outcome. This association is likely related to differences in patient characteristics rather than differences in clinical management. Chest pain may represent a clinical marker of lower disease severity. Further multicenter studies are needed to clarify the underlying mechanisms and to evaluate the potential integration of chest pain into risk stratification models.