Section of Internal and Cardiopulmonary Medicine, University of Ferrara, Ferrara, Italy; Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy.
Department of Cardiovascular Diagnosis and Endoluminal Interventions, Santa Maria della Misericordia Hospital, Rovigo, Italy.
Thromb Res. 2019 Jan;173:117-123. doi: 10.1016/j.thromres.2018.11.029. Epub 2018 Nov 29.
The temporal window for the administration of systemic thrombolysis (ST) in acute pulmonary embolism (PE) has not yet been clarified. We assessed the relationship between short-term cardiovascular (CV) mortality and time of ST administration.
Among 394 consecutive patients admitted between January 2010 and June 2017 with a confirmed PE, we retrospectively review the clinical and instrumental data of those labelled as high-risk PE (n = 76, 41 males, mean aged 64.7 ± 9.1 years old).
A receiving operating curve (ROC) analysis established the optimal temporal threshold for the administration of the ST, in respect to the 30-day CV mortality at 8.5 h from the symptom onset (Area under Curve 0.79 ± 0.6, 95% CI 0.73-0.86, p < 0.0001). Mantel-Cox analysis showed that there was a significant difference in the distribution of survival between patients treated within 8.5 h from the beginning of symptoms onset to those treated after 8.6 h [log rank (Mantel-Cox) chi-square 9.68 p = 0.002]. Cox-regression analysis demonstrated that the administration of ST after 8.6 h from the symptom's onset was an independent predictor of 30-day CV mortality in high-risk PE patients (HR 7.81, 95% CI 1.84-33.05, p = 0.005), independently from the occurrence of major bleeding events (HR 5.89, 95% CI 1.38-25.13, p = 0.01), previous CAD (HR 3.31, 95& CI 1.07-10.231. p = 0.03), RV/LV ratio after 2 h from the administration ST > 1 (HR (12.91, 95% CI 3.04-54.77, p = 0.001) and PAH at discharge (HR 3.86, 95% CI 2.22-4.68, p = 0.002).
ST administered within 8.5 h from symptoms onset may be associated with a reduced 30-day CV mortality in high-risk PE patients.
急性肺栓塞（PE）患者全身溶栓（ST）治疗的时间窗尚未明确。我们评估了短期心血管（CV）死亡率与 ST 治疗时间之间的关系。
在 2010 年 1 月至 2017 年 6 月期间连续收治的 394 例确诊为 PE 的患者中，我们回顾性分析了标记为高危 PE（n=76，41 名男性，平均年龄 64.7±9.1 岁）患者的临床和仪器数据。
接收者操作曲线（ROC）分析确定了 ST 治疗的最佳时间阈值，以 30 天 CV 死亡率为指标，从症状发作起 8.5 小时（曲线下面积 0.79±0.6，95%CI 0.73-0.86，p<0.0001）。Mantel-Cox 分析显示，在症状发作开始后 8.5 小时内接受治疗的患者与 8.6 小时后接受治疗的患者之间，生存分布存在显著差异[对数秩（Mantel-Cox）卡方检验 9.68，p=0.002]。Cox 回归分析表明，高危 PE 患者症状发作后 8.6 小时开始 ST 治疗是 30 天 CV 死亡率的独立预测因素（HR 7.81，95%CI 1.84-33.05，p=0.005），独立于主要出血事件的发生（HR 5.89，95%CI 1.38-25.13，p=0.01）、既往 CAD（HR 3.31，95%CI 1.07-10.23，p=0.03）、ST 治疗后 2 小时 RV/LV 比值>1（HR 12.91，95%CI 3.04-54.77，p=0.001）和出院时 PAH（HR 3.86，95%CI 2.22-4.68，p=0.002）。
高危 PE 患者在症状发作后 8.5 小时内进行 ST 治疗可能与 30 天 CV 死亡率降低相关。
