1 Department of Radiology, University of Arkansas for Medical Sciences, 4301 W Markham St, Slot 556, Little Rock, AR 72205.
2 Division of Interventional Radiology, Johns Hopkins Hospital, Baltimore, MD.
AJR Am J Roentgenol. 2018 Sep;211(3):672-676. doi: 10.2214/AJR.17.19332. Epub 2018 Jul 17.
Pulmonary embolism (PE) is associated with a higher mortality rate in patients with congestive heart failure (CHF) than in those without heart failure. The purpose of this study was to evaluate if inferior vena cava (IVC) filter placement provides any mortality benefit in patients admitted with CHF and PE.
The 2005-2014 Nationwide Inpatient Sample (NIS) was used for this study. Adults (≥ 18 years old) with PE were identified using International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) diagnosis codes. Patients with CHF were identified using the Elixhauser comorbidity variable (CM_CHF) in the NIS database. IVC filter placement was identified using the ICD-9-CM procedure code 38.7 (interruption of the vena cava). A multivariate logistic regression model was used to determine the association of IVC filter placement with in-hospital mortality. The model was adjusted for demographics, hospital characteristics, comorbidities, and PE severity indexes (pressor dependence, mechanical ventilation, nonseptic shock, and use of thrombolytic therapy).
During the study years, 425,877 patients with a comorbidity of CHF were hospitalized with PE (44% male; mean age, 71.5 years old). Of them, 67,237 patients (15.8%) received an IVC filter during the admission, and 50,338 (11.8%) died during the hospital stay. The all-cause in-hospital mortality rate among patients who received an IVC filter was 9.7% (6541 of 67,237 patients) compared with 12.2% (43,796 of 358,638 patients) among those without an IVC filter (p < 0.001), with an absolute risk reduction of 2.5%. The multivariate adjusted hazard ratio of in-hospital mortality associated with IVC filter placement was 0.535 (95% CI, 0.518-0.551; p < 0.001).
A lower all-cause mortality rate was observed in patients with CHF and PE who received an IVC filter while hospitalized. In the absence of data from randomized controlled trials, this study suggests that IVC filters could help prevent in-hospital death among patients admitted with PE and CHF.
与无心力衰竭的患者相比，充血性心力衰竭（CHF）合并肺栓塞（PE）患者的死亡率更高。本研究旨在评估下腔静脉（IVC）滤器置入是否能为合并 CHF 和 PE 的患者带来任何生存获益。
本研究使用了 2005-2014 年全国住院患者样本（NIS）。使用国际疾病分类，第 9 修订版，临床修正（ICD-9-CM）诊断代码识别 PE 患者。使用 NIS 数据库中的 Elixhauser 合并症变量（CM_CHF）识别 CHF 患者。IVC 滤器放置通过 ICD-9-CM 程序代码 38.7（腔静脉中断）确定。采用多变量逻辑回归模型确定 IVC 滤器放置与院内死亡率的关系。该模型调整了人口统计学、医院特征、合并症和 PE 严重程度指标（依赖升压药、机械通气、非感染性休克和溶栓治疗的使用）。
在研究期间，425877 例患有 CHF 合并症的患者因 PE 住院（44%为男性；平均年龄为 71.5 岁）。其中，67237 例（15.8%）患者在入院期间接受了 IVC 滤器治疗，50338 例（11.8%）在住院期间死亡。接受 IVC 滤器治疗的患者全因院内死亡率为 9.7%（6541 例/67237 例），而未接受 IVC 滤器治疗的患者为 12.2%（43796 例/358638 例）（p<0.001），绝对风险降低 2.5%。多变量校正后与 IVC 滤器放置相关的院内死亡风险比为 0.535（95%置信区间，0.518-0.551；p<0.001）。
在因 PE 和 CHF 住院的患者中，接受 IVC 滤器治疗的患者全因死亡率较低。在缺乏随机对照试验数据的情况下，本研究表明，IVC 滤器可能有助于预防因 PE 和 CHF 住院的患者死亡。
