Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa, Iowa City, Iowa; Section of Vascular Medicine, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, Ohio.
Am J Cardiol. 2019 Nov 1;124(9):1465-1469. doi: 10.1016/j.amjcard.2019.07.043. Epub 2019 Aug 7.
Treatment strategies for complex patients with pulmonary embolism (PE) are often debated given patient heterogeneity, multitude of available treatment modalities, and lack of consensus guidelines. Although multidisciplinary Pulmonary Embolism Response Teams (PERT) are emerging to address this lack of consensus, their impact on patient outcomes is not entirely clear. This analysis was conducted to compare outcomes of all patients with PE before and after PERT availability. We analyzed all adult patients admitted with acute PE diagnosed on computed tomography scans in the 18 months before and after the institution of PERT at a large tertiary care hospital. Among 769 consecutive inpatients with PE, PERT era patients had lower rates of major or clinically relevant nonmajor bleeding (17.0% vs 8.3%, p = 0.002), shorter time-to-therapeutic anticoagulation (16.3 hour vs 12.6 hour, p = 0.009) and decreased use of inferior vena cava filters (22.2% vs 16.4%, p = 0.004). There was an increase in the use of thrombolytics/catheter-based strategies, however, this did not achieve statistical significance (p = 0.07). There was a significant decrease in 30-day/inpatient mortality (8.5% vs 4.7%, p = 0.03). These differences in outcomes were more pronounced in intermediate and high-risk patients (mortality 10.0% vs 5.3%, p = 0.02). The availability of multidisciplinary PERT was associated with improved outcomes including 30-day mortality. Patients with higher severity of PE seemed to derive most benefit from PERT availability.
由于患者异质性、多种可用治疗方法以及缺乏共识指南，复杂肺栓塞 (PE) 患者的治疗策略经常存在争议。尽管多学科肺栓塞反应团队 (PERT) 的出现旨在解决这一共识缺失问题，但它们对患者结局的影响尚不完全清楚。这项分析旨在比较 PERT 可用前后所有 PE 患者的结局。我们分析了一家大型三级护理医院在 PERT 实施前和实施后 18 个月内通过计算机断层扫描诊断为急性 PE 的所有成年住院患者。在 769 例连续住院的 PE 患者中，PERT 时代患者的主要或临床相关非重大出血发生率较低（17.0% vs 8.3%，p=0.002），达到治疗抗凝时间较短（16.3 小时 vs 12.6 小时，p=0.009），下腔静脉滤器使用率降低（22.2% vs 16.4%，p=0.004）。溶栓/基于导管的策略的使用有所增加，但未达到统计学意义（p=0.07）。30 天/住院死亡率显著降低（8.5% vs 4.7%，p=0.03）。这些结局差异在中高危患者中更为明显（死亡率 10.0% vs 5.3%，p=0.02）。多学科 PERT 的可用性与改善结局相关，包括 30 天死亡率。PE 严重程度较高的患者似乎从 PERT 的可用性中获益最大。
