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Catheter-directed interventions compared with systemic thrombolysis achieve improved ventricular function recovery at a potentially lower complication rate for acute pulmonary embolism
- Publication Year :
- 2018
-
Abstract
- OBJECTIVE: Catheter-directed interventions (CDIs) are increasingly performed for acute pulmonary embolism (PE) as they are presumed to provide similar therapeutic benefits to systemic thrombolysis (ST) while decreasing the associated complications. The purpose of this study was to compare outcomes between CDI and ST. METHODS: Consecutive patients who underwent CDIs or ST for massive or submassive PE between 2006 and 2016 were identified. Clinical and echocardiographic parameters at baseline and after treatment were recorded. Clinical success was defined as decompensation resolution (or prevention) without major bleeding, stroke, other major treatment-related event, or in-hospital death. The χ(2) test and t-test were used for between-groups comparisons. RESULTS: There were 213 patients who received CDIs (standard catheter thrombolysis in 56, ultrasound-assisted thrombolysis in 146, suction thrombectomies in 10, and pharmacomechanical thrombolysis in 1) and 104 patients who received ST (94 high dose [100 mg], 10 low dose [50 mg]). At baseline, CDI and ST groups had comparable echocardiographic parameters, demographics, and comorbidities, except for PE type (massive PE, 8.5% for CDIs vs 69.2% for ST; P < .001), age (60.2 ± 14.9 years for CDIs vs 55.9 ± 17.3 years for ST; P =.023), and renal function (glomerular filtration rate, 78.1 ± 33.7 mL/min/1.73 m(2) for CDIs vs 64.1 ± 35.2 mL/min/1.73 m(2) for ST; P =.001). Without stratifying per PE type, CDIs had a higher clinical success rate (87.8% vs 66.3%; P < .001) and a lower rate of major bleed (8.0% vs 19.2%; P =.003), stroke (1.4% vs 4.8%; P = .120), and death (1.4% vs 13.5%; P < .001). On stratifying by PE type, there was no difference in clinical success between groups. The mean reduction in right ventricular/left ventricular diameter ratio between baseline and the first post-treatment echocardiographic examination (within 30 days) was significantly higher for CDI (0.27 ± 0.20 vs 0.18 ± 0.15; P =.037). Beyond 30 days, there was no echocardiographic difference between groups. There was no significant difference in clinical outcomes and echocardiographic parameters between standard and ultrasound-assisted CDIs. CONCLUSIONS: CDIs provide improved recovery of right ventricular function compared with ST. Major bleeding and stroke complications may be lower, but larger studies are needed to validate this. CDIs are complementary to ST, and their use should be individualized on the basis of the patients’ clinical presentation, risk profile, and local resources.
- Subjects :
- Adult
Male
medicine.medical_specialty
Time Factors
medicine.medical_treatment
Ventricular Dysfunction, Right
030204 cardiovascular system & hematology
Article
03 medical and health sciences
0302 clinical medicine
Fibrinolytic Agents
Risk Factors
Internal medicine
Catheterization, Peripheral
medicine
Humans
Decompensation
Thrombolytic Therapy
030212 general & internal medicine
Infusions, Intravenous
Propensity Score
Stroke
Aged
Retrospective Studies
Chi-Square Distribution
business.industry
Retrospective cohort study
Thrombolysis
Recovery of Function
Middle Aged
medicine.disease
Pulmonary embolism
Catheter
Treatment Outcome
Echocardiography
Propensity score matching
Acute Disease
Cardiology
Ventricular Function, Right
Surgery
Female
Cardiology and Cardiovascular Medicine
business
Pulmonary Embolism
Chi-squared distribution
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....3f06cfc201cb69b1cfe459bc32c63e1b