犬肺血栓栓塞症模型的改进

目的 :为解决监测犬D 二聚体的试剂盒获取不易、价格昂贵的问题 ,改进犬急性肺血栓栓塞症 (PTE)的模型 ,探讨该模型在急性PTE研究中的价值。方法 :采用犬自体血加凝血酶加人纤维蛋白原制备的自体血栓 ,由股静脉输入建立急性PTE的模型 ,并分别与不同的 2组对照组比较。监测肺血流动力学的变化 ,作肺动脉造影、螺旋CT及螺旋CT血管造影 ,栓塞前及栓塞后多时点留取血样测血浆D 二聚体浓度。栓塞后 1d ,5d ,10d分别处死部分犬做病理解剖学观察。结果 :实验组及对照Ⅰ组均存在肺动脉栓塞。栓塞后即刻肺动脉收缩压 (PASP)、肺动脉舒张压 (PADP)明显上升 ,自身前后及与对照Ⅱ组比较有显著性差异 (P <0 0 5 )。实验组血浆D 二聚体于栓塞后 30min明显上升 ,1～ 2h达高峰 ,2 4h后下降 ,自身前后及与对照Ⅰ组、对照Ⅱ组比较 ,有显著性差异 (P <0 0 5 )。结论 :犬急性PTE模型改进成功。血浆D 二聚体在急性PTE早期有一个相对特征性的动态变化过程 ,动态检测血浆D 二聚体有助于急性PTE的早期诊断。     

肌红蛋白、肌钙蛋白T、肌酸激酶同工酶的检测对老年急性心肌梗死溶栓再通的判定价值

目的　探讨血清肌红蛋白 (Mb)、肌钙蛋白T(cTnT)和肌酸激酶同工酶 (CK MB)对老年急性心肌梗死溶栓疗效的早期判定价值。方法　应用酶联免疫分析法测定 32例老年急性心肌梗死患者溶栓治疗后的Mb、cTnT、CK MB浓度 ,分析急性心肌梗死患者溶栓再通组 ( 1 8例 )和溶栓未通组 ( 1 4例 )上述指标的变化。结果　急性心肌梗死溶栓再通组Mb、cTnT和CK MB达到峰值浓度的时间明显较未通组提前 ( P <0 .0 5) ,其中Mb较cTnT和CK MB峰值出现更早 ,分别为( 7.4± 2 .5)h、( 1 3.7± 4.1 )h和 ( 1 4.4± 2 .7)h (P <0 .0 1 ) ;Mb的诊断敏感性 ( 79% )与诊断效率( 87% )明显高于cTnT( 6 0 %、75% )和CK MB( 47%、6 7% ) (P <0 .0 1 )。结论　血清Mb、cTnT和CK MB水平及其变化可以较好地早期预测急性心肌梗死患者溶栓再通 ,其中Mb较cTnT及CK MB具有更好的的临床价值。     

45例不稳定心绞痛患者心肌酶的测定与冠状动脉造影的分析

目的　探讨肌钙蛋白Ⅰ (cTnⅠ )及肌酸激酶同工酶 (CK MB)阳性的不稳定心绞痛患者 ,与其冠状动脉病变的关系 ,从而判断病人的预后。　方法　在心绞痛发作后的 4、8、12、16小时采血 ,测定 4 5例不稳定心绞痛患者的cTnⅠ及CK MB ,1周内行冠状动脉造影检查。　结果　 1 cTnⅠ阳性的不稳定心绞痛患者较cTnⅠ阴性的不稳定心绞痛患者 ,其临床症状重 ,冠状动脉病变严重 ,复杂并有显著差异 (P <0 0 1) ,2 CK MB阳性的不稳定心绞痛患者 ,较CK MB阴性的不稳定心绞痛患者其临床症状重 ,冠状动脉病变严重、复杂 ,亦有显著差异 ( P <0 0 1) ,3 cTnⅠ阳性的不稳定心绞痛患者与CK MB阳性的不稳定心绞痛患者比较则无显著差异 (P >0 0 5 )。　结论　cTnⅠ与CK MB阳性者有对不稳定心绞痛患者的冠状动脉病变具有预测性。     

犬实验性肺血栓栓塞症后血清乳酸脱氢酶同工酶3和血浆D-二聚体的动态研究

目的　动态监测犬肺血栓栓塞症 (PTE)后血清乳酸脱氢酶同工酶 3(L DH3)与血浆 D-二聚体的变化 ,探讨两者在急性 PTE诊断中的价值。方法　采用健康杂种犬 18只 ,随机分为三组。栓塞 组采用自体血加凝血酶及人纤维蛋白原制备的自体血栓 ,由股静脉输入建立急性 PTE模型。栓塞 组不加人纤维蛋白原 ,余同栓塞 组。对照组由股静脉输入生理盐水加人纤维蛋白原。三组均于栓塞前后做肺动脉造影及螺旋 CT血管造影 ,栓塞前及栓塞后多时点留取血样测 L DH3及血浆 D-二聚体浓度。结果　肺动脉造影及螺旋 CT血管造影均证实犬 PTE模型制备成功。栓塞 组血浆 D-二聚体于栓塞后 30 m in明显上升 ,2 4 h后明显下降 ,自身前后比较及与栓塞 组、对照组比较 ,差异有显著性 (P<0 .0 5 )。栓塞 ( 、 )组栓塞后 2 h至 4 d L DH3明显升高 ,与栓塞前及对照组比较差异有显著性 (P<0 .0 5 )。结论　血浆 D-二聚体、L DH3在急性 PTE早期有一个相对特征性的动态变化过程 ,联合检测 D-二聚体、L DH3有助于急性 PTE的早期诊断。     

急性大面积肺血栓栓塞症的介入治疗

目的评估介入治疗急性大面积肺血栓栓塞症(PTE)的临床疗效。方法对15例急性大面积PTE病人进行猪尾导管碎栓抽吸血栓联合局部溶栓治疗,根据血管再通情况酌情全身溶栓,然后抗凝治疗,观察休克指数、体循环平均压、肺动脉平均压的变化。结果休克指数与体循环平均压介入后即刻与介入前相比下降显著,介入后48h继续下降,P值<0.05,均有显著性差异。肺动脉平均压介入前与介入后即刻相比改善无显著性,介入后48h改善,P值<0.05,有显著性差异。手术前后血管再通率为32.4±15.6%,无导管相关并发症,死亡率20%。结论肺血栓栓塞症的介入治疗是一种安全、有效的方法,改善近期预后,适用于急性或亚急性PTE患者,尤其适用于有溶栓禁忌症的患者。     

犬急性肺血栓栓塞部分血管活性物质的实验研究

目的　探讨内皮素(ET)、一氧化氮(NO)、肾上腺髓质素(ADM)和C型利钠肽(CNP)在肺血栓栓塞时的变化及对血流动力学的影响。方法　14只健康杂种犬随机分为肺栓塞组和对照组。栓塞组注射自体血栓,对照组注射温生理盐水。每只犬在注栓前、注栓后的半小时、1、2、4及6h各时点记录血流动力学指标和进行动脉血气分析,收集动脉血标本,检测ET、CNP、ADM和NO的变化。结果　组织病理符合肺血栓栓塞的改变;栓塞组在栓塞后动脉血气血氧分压较栓塞前及对照组明显降低(P <0 .0 5 ) ;栓塞组在栓塞后平均肺动脉压(MPAP)和肺血管阻力(PVR)较栓塞前及对照组明显升高(P<0 .0 5 ) ;与对照组比较,ET和NO在栓塞后2、4及6h明显升高(P <0 .0 5 )。ADM在栓塞后1、2h明显升高(P <0 .0 5 ) ;CNP在栓塞后2h明显升高(P <0 .0 5 )。结论　血管活性物质ET、NO、ADM和CNP参与急性肺血栓栓塞的病理生理过程。     

心肌肌钙蛋白Ⅰ对肺炎心衰的诊断意义

目的　观察血清cTnⅠ在诊断支气管肺炎合并心衰中的意义。　方法　将观察对象分为三组 :肺炎心衰组、普通肺炎组、正常对照组 ,每组各 30例。检测各组患儿血清cTnⅠ和血清CK MB水平。　结果　肺炎心衰组血清cTnⅠ 2 2例升高 ,占 73 3%,普通肺炎组和正常对照组无一例升高。三组间检测结果比较存在显著性差异(P <0 0 5 )。　结论　血清cTnⅠ是肺炎心衰早期诊断的高敏感、高特异性的血清学指标 ,优于CK -MB。     

肌酸激酶、肌酸激酶同工酶、心肌肌钙蛋白T对射频消融所致心肌损伤检测的比较

目的 :比较肌酸激酶 ( CK)、肌酸激酶同工酶 ( CK- MB)及心肌肌钙蛋白 T( c Tn T) 3项指标对射频导管消融术 ( RFCA)所致微小心肌损伤 ( MMD)的诊断价值 ,探索利用 c Tn T判断心肌损伤程度的简便方法。方法 :对30例行 RFCA的室上性心动过速患者进行了上述 3项指标的动态监测。结果 :RFCA前 ,30例患者 CK、CK- MB、c Tn T均在正常范围。 c Tn T在 RFCA后即刻显著升高 ,由 RFCA前的 ( 0 .13± 0 .0 5 ) μg/L 升至 ( 0 .5 7± 0 .47) μg/L ,4h达峰值 ( 1.10± 0 .98)μg/L ,72 h恢复至 RFCA前水平。 RFCA后即刻 c Tn T浓度平均升高达 ( 5 .2± 3.1)倍 ,明显高于 CK、CK- MB的升高倍数 ( P <0 .0 1)。 c Tn T达峰值时较 RFCA前升高 ( 11.8± 6 .5 )倍 ,明显高于CK、CK- MB的升高倍数 ( P <0 .0 1)。 c Tn T和 CK- MB于 RFCA后 4h左右达峰值 ,明显早于 CK达峰值的时间( P<0 .0 1)。 RFCA后 c Tn T升高超过界值者占 93% ,显著高于 CK、CK- MB升高超过界值者的比例 ( P<0 .0 1)。结论 :RFCA后 c Tn T达峰早 ,即刻及峰值升高倍数明显高于 CK与 CK- MB,是检测 RFCA所致 MMD的优良指标 ;RFCA所致 MMD可由动态监测得出的 c Tn T峰值来判断     

体外电复律对恶性心律失常患者心肌酶谱及肌钙蛋白Ⅰ的影响

目的探讨临床体外电复律对恶性心律失常患者心肌酶谱及肌钙蛋白I的影响。方法院前及院内恶性心律失常患者,排除胸廓及心脏外伤患者以及既往心梗患者,经体外电复律成功后,根据冠脉造影和电复律成功后心电图表现分为非急性心梗组和急性心梗组。分析体外电复律对两组电复律前或即刻和12h血清CK、CK—MB、cTnI的影响。结果非急性心梗组及急性心梗组分别有22例和30例患者,两组电复律累积次数及能量差异无统计学意义[（3．0±1．2）次比（3．0±1．3）次;（446±275）J比（450±293）J,P〉0．05];体外电复律前或即刻及12h,非急性心梗组与急性心梗组相比,CK12[（452．3±204．2）U／L比（562．2±234．1）U／L]、CK—MB0[（10．6±7．5）U／L比[27．1±12．3）U／LJ、CK—MB12[（30．0±20．5）U／L比（180．5±62．3）U／L]、cTnI0[（0．04±0．04）ng／ml比（0．58±0．86）ng／ml]、cTnI12[（0．06＋0．04）ng／ml比（17．47±12．07）ng／ml]差异有统计学意义（P〈0．01）,除外CK0[（129．2±90．5）U／L比（135．3±94．8）U／L,P〉0．05]。体外电复律后12h较电复律前或即刻CK、CK—MB、cTnI均显著升高（P〈0．05或P〈0．01）。CK—MB0、CK—MB12、cTn10、cTnI12阳性率,非急性心梗组分别为9．1％、54．5％、0、0,急性心梗组分别为53．3％、90．0％、20．0％、93．3％。结论体外电复律可导致恶性心律失常患者CK、CK—MB、eTnI升高,但eTnI升高程度并不影响急性心梗的诊断。     

吸入一氧化氮在肺动脉栓塞术后肺动脉高压的临床应用

目的:评价吸入一氧化氮(nitric oxide,NO)对肺动脉栓塞外科手术治疗后肺动脉高压(pulmonary arterial hypertension,PH)患者的治疗作用。方法:回顾性分析安贞医院2005年1月1日至2011年8月1日,62例接受外科手术治疗的肺动脉栓塞患者临床资料,15例患者在肺动脉栓塞外科手术治疗后仍存在PH时,吸入NO浓度为(10～30)×10-6,记录NO吸入时间、吸入时呼吸功能指标和血流动力学参数。结果:术后平均吸入NO时间(46.3±6.4)h,动脉血氧饱和度(SaO2)、动脉血氧分压(PaO2)、动脉血氧分压与吸入氧浓度比值(PaO2/FiO2)较吸入前改善,平均肺动脉压(mPAP)较吸入前下降(P<0.05)。结论:对于肺动脉栓塞术后PH患者吸入NO,可以改善氧合并降低肺动脉压力。     

Meconium aspiration induces ARDS-like pulmonary response in lungs of ten-week-old pigs

To investigate whether aspiration of meconium induces a hemodynamic and histologic pulmonary response similar to that frequently seen in experimental acute respiratory distress syndrome, twelve 10-week-old pigs with postnatally adapted lungs were studied. Six 10-week-old pigs received 3 ml/kg 20% human meconium via the endotracheal tube. Six control pigs of the same age were given sterile saline. Ventilator settings were adjusted to keep PaO₂ above 8 kPa and PaCO₂ below 5 kPa. The pulmonary hemodynamic response to aspiration consisted of two separate hypertensive components. An initial peak in pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) was followed by a progressive increase in PAP and PVR in the meconium group, whereas in the saline group these parameters returned to baseline levels. The distribution of PVR, determined by pulmonary artery occlusion, was characterized by an increase in the postarterial resistance immediately after meconium aspiration and a progressive increase in both arterial and postarterial resistances during the later phase. On histological examination, marked neutrophil sequestration was seen in the meconium lungs. In addition, lung edema formation was significantly enhanced in the meconium group, as shown by an increased lung wet/dry weight ratio. Thus, meconium aspiration resulted in a biphasic pulmonary pressor response and severe pulmonary inflammation. This response resembled that of models of experimental acute respiratory distress syndrome following diverse types of precipitating insults; this suggests that similar pathophysiologic mechanisms are elicited and cause similar pulmonary dysfunction following different forms of lung injury. Pediatr. Pulmonol. 1997; 23:205–211 © 1997 Wiley-Liss, Inc.     

犬多发性肺动脉微小血栓栓塞的病理及呼吸循环功能改变

目的：了解多发性肺动脉微小血栓栓塞在犬动物模型中对肺组织形态，循环功能，呼吸功能和凝血纤溶指标的影响，方法：健康成年杂种犬13只，随机分为2组，栓塞组7只，对照组6只，取自体血10ml制成1－2mm大小血栓，给栓塞组动物1次注入300个微小血栓，检测栓塞关，栓塞即刻，30min,1h和2h，血流动力学和氮动力学的变化。结果：肺栓塞后即刻出现肺动脉压（PAP）明显升高，1h后下降，对通气功能影响不大，D－二聚体（D－dimer)在30min后开始升高，病理可见肺出血，肺实变和微小动脉血栓形成，结论；肺动脉微小血栓栓塞可引起肺组织水肿，出血和肺动脉内血栓形成，并在栓塞早期引起肺动脉高压，但对通气功能的影响不明显，D－dimer在微小血栓栓塞早期即有明显变化。     

Frequency and clinical implications of discordant creatine kinase-MB and troponin measurements in acute coronary syndromes.

OBJECTIVES: We sought to evaluate the association between discordant cardiac marker results and in-hospital mortality and treatment patterns in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS). BACKGROUND: Creatine kinase-MB (CK-MB) and cardiac troponins (cTn) are often measured concurrently in patients with NSTE ACS. The significance of discordant CK-MB and cTn results is unknown. METHODS: Among 29,357 ACS patients in the CRUSADE initiative who had both CK-MB and cTn measured during the first 36 hours, we examined relationships of four marker combinations (CK-MB-/cTn-, CK-MB+/cTn-, CK-MB-/cTn+, and CK-MB+/cTn+) with mortality and American College of Cardiology/American Heart Association guidelines-recommended acute care. RESULTS: The CK-MB and cTn results were discordant in 28% of patients (CK-MB+/cTn-, 10%; CK-MB-/cTn+, 18%). In-hospital mortality was 2.7% among CK-MB-/cTn- patients; 3.0%, CK-MB+/cTn-; 4.5%, CK-MB-/cTn+; and 5.9%, CK-MB+/cTn+. After adjustment for other presenting risk factors, patients with CK-MB+/cTn- had a mortality odds ratio (OR) of 1.02 (95% confidence interval [CI] 0.75 to 1.38), those with CK-MB-/cTn+ had an OR of 1.15 (95% CI 0.86 to 1.54), and those with CK-MB+/cTn+ had an OR of 1.53 (95% CI 1.18 to 1.98). Despite variable risk, patients with CK-MB+/cTn- and CK-MB-/cTn+ were treated similarly with early antithrombotic agents and catheter-based interventions. CONCLUSIONS: Among patients with NSTE ACS, an elevated troponin level identifies patients at increased acute risk regardless of CK-MB status, but an isolated CK-MB+ status has limited prognostic value. Recognition of these risk differences may contribute to more appropriate early use of antithrombotic therapy and invasive management for all cTn+ patients.     

NT-proBNP与cTnⅠ在评估老年中高危肺栓塞合并右心功能障碍患者病情中的应用价值

目的 探讨血浆N末端B型利钠肽原(NT-proBNP)、心肌肌钙蛋白Ⅰ(cTnⅠ)在评估老年急性中高危肺栓塞合并右心功能障碍患者病情中的应用价值.方法 选取2015年1月至2016年6月新疆医科大学第一附属医院收治的老年急性中高危肺栓塞合并右心功能障碍的59例患者作为合并组,另选取85例未发生右心功能障碍的老年急性中高危肺栓塞患者作为非合并组,以及50名体检健康者作为对照组.采集所有研究对象清晨空腹外周静脉血,应用免疫荧光法测定患者血浆NT-proBNP及cTnⅠ指标,采集血液标本的同时进行超声心动图检查,对比各组NT-proBNP、cTnⅠ指标的差异性,并应用特征曲线分析影响急性中高危肺栓塞患者临床预后结局的主要因素.结果 3组NT-proBNP、cTnⅠ指标比较差异均有统计学意义(P值均＜0.05),并且合并组患者右心室舒张末期内径明显高于非合并组与对照组(P值均＜0.05).受试者工作特征曲线显示NT-proBNP、cTnⅠ曲线下面积均大于90％,logistic回归分析显示NT-proBNP、cTnⅠ指标、右心功能障碍与患者临床预后具有密切联系.结论 NT-proBNP、cTnⅠ指标不仅在诊断急性中高危肺栓塞合并右心功能障碍中具有重要意义,同时能够对患者的临床预后转归提供良好、准确的评估,可作为指导肺栓塞患者临床治疗的简单、灵敏的标志物.     

肌红蛋白和心肌肌钙蛋白I联合快速检测对急性心肌梗死的早期诊断价值

目的探讨两种心肌损伤标志物肌红蛋白(Mb)及心肌肌钙蛋白I(cTn I)联合快速检测定性分析对急性心肌梗死(AMI)的早期诊断价值.方法因胸痛发作发病3 h～6 h,临床疑诊为AMI的病人120例.入院后即刻在床边采集静脉血测定Mb和cTn I,比较Mb、cTn I诊断AMI的敏感性、特异性、准确性、阳性预测值和阴性预测值.结果 Mb的敏感性、阴性预测值均为100.0%,cTn I为94.4%和92.0%,Mb明显高于cTn I(P<0.05或P<0.01);而cTn I的准确性、特异性和阳性预测值分别为95.0%、95.8%和97.1%,Mb为83.3%、58.3%和78.3%,cTn I明显高于Mb(P<0.05或P<0.01);采用Mb联合cTn I检测,其特异性达到100.0%,高于单纯Mb和cTn I检测,有统计学意义(P<0.01).结论 Mb及cTn I快速联合检测有助于早期诊断或排除AMI,方法简便快捷,适合于急诊及院前急救.     

重组人脑钠肽注射液治疗急性失代偿性心力衰竭患者的疗效和安全性

目的:应用Swan-Ganz导管进行血流动力学监测,评价重组人脑钠肽注射液(商品名:奈西立肽)药物治疗急性失代偿性心力衰竭(急性心衰)患者的疗效和安全性. 方法:本研究有中国5家心血管临床研究中心参加,人选40例急性心衰患者.患者用药前应用Swan-Ganz导管进行血流动力学监测,使用奈西立肽先静脉注射2μg/kg,之后,持续静脉泵入0.01μg/(kg·min)24小时.分别在用药前、用药后15 min、1 h、3 h、24 h测量并记录肺毛细血管楔压(PCWP)、肺动脉压(PAP)和心脏排血指数(CI).同时记录治疗前、后的呼吸困难程度、其他临床症状以及全身临床情况的评估.用药过程中及用药后定期测量血压、心率、呼吸频率以及相关的血液生化指标,并对用药过程中出现所有不良事件进行记录,进行安全性评估. 结果:本试验40名受试者都完成了24小时治疗.用药后肺毛细血管楔压、肺动脉收缩压显著性下降、心脏排血指数显著性增高.用药后各观察时间点与用药前比较,差异均有统计学意义(P相似文献   

Role of echocardiography in acute pulmonary embolism

The difficulty in making an accurate diagnosis of acute pulmonary embolism is well known. To clarify the role of echocardiography, including Doppler echocardiography, in acute pulmonary embolism, we examined hemodynamic and echocardiographic parameters in 9 patients with acute pulmonary embolism just before and after treatment with urokinase. As hemodynamic parameters normalized after treatment, echocardiographic parameters such as deformity index of the left ventricle (LV-DI), end-diastolic dimension of the right ventricle (RVDd), the left ventricle (LVDd), the inferior vena cava, and RVDd/LVDd all significantly changed toward normal. Highly significant correlations were found between the echocardiographic and hemodynamic parameters, the best of which was between the LV-DI and systolic pulmonary artery pressure (r = -0.885, p less than 0.001). Doppler echocardiography quantitatively evaluated the grade of tricuspid regurgitation, and accurately estimated systolic pulmonary artery pressure. We conclude that echocardiography, including Doppler echocardiography, sensitively reflects the right ventricular pressure and volume overload of acute pulmonary embolism, is quite useful for its diagnosis which is often difficult, and is suitable for noninvasive follow up of these patients.     

吸入伊洛前列腺素在先天性心脏病伴发肺动脉高压患者中的急性血管反应试验

目的:观察吸入伊洛前列腺素对先天性心脏病伴发肺动脉高压者的急性血管反应。方法:予15例患者(室间隔缺损10例,房间隔缺损3例,动脉导管未闭及心内膜垫缺损各1例)吸入氧气15min,而后吸入20μg伊洛前列腺素,测量吸氧前后、吸药后即刻、15min及30min的肺动脉和股动脉压并取各部位血测值。结果:吸药后即刻肺动脉平均压及全肺阻力较吸氧前明显降低(P<0.001),而左心排血指数未见明显变化(P=0.244),试验过程中患者未出现不良反应。结论:在急性血管反应试验中,使用雾化吸入的伊洛前列腺素可以安全、有效的在短时间内选择性扩张肺血管、降低肺动脉压力及肺循环阻力,而对体循环影响较小。     

Predictors of In‐Hospital and Long‐Term Clinical Outcome in Elderly Patients with Massive Pulmonary Embolism Receiving Thrombolytic Therapy

OBJECTIVES: To determine the clinical, historical, and instrumental findings associated with unfavorable short‐term and long‐term prognosis in elderly patients (≥65) receiving thrombolytic therapy for pulmonary embolism (PE). DESIGN: Case‐control retrospective study. SETTING: General medicine acute care ward. PARTICIPANTS: Sixty‐seven elderly patients with PE complicated by hemodynamic instability (massive PE) admitted to the “Antonio Cardarelli” Hospital from January 1, 2002, to December 31, 2004, and evaluated during their hospital stay and 174.4±4.6 days after discharge. MEASUREMENTS: PE diagnosis was confirmed using spiral computed tomography angiography. Hemodynamic instability was defined as cardiogenic shock and systolic blood pressure less than 90 mmHg or a pressure drop of 40 mmHg or more for longer than 15 minutes not due to new‐onset arrhythmia, hypovolemia, or sepsis. INTERVENTION: Weight‐adapted unfractionated heparin and recombinant tissue plasminogen activator. RESULTS: Nine patients (13.4%) died during hospitalization. Higher troponin‐I (cTn‐I) serum levels at admission to the emergency department and the occurrence of thrombocytopenia after thrombolysis were significantly associated with in‐hospital death. Nineteen of the 58 survivors (32.7%) died during follow‐up. The risk factors for long‐term death were historical findings of cancer and cardiovascular disease at hospital admission. CONCLUSION: Higher cTn‐I serum levels in the acute phase and the occurrence of thrombocytopenia after thrombolysis were significantly associated with in‐hospital mortality in elderly patients with massive PE. In the same setting, historical findings of cancer and cardiovascular disease are strong predictors of death in the long term.