Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Division of Cardiovascular Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
Ann Thorac Surg. 2020 Aug;110(2):441-447. doi: 10.1016/j.athoracsur.2020.02.024. Epub 2020 Mar 19.
Guidelines outlining the role of surgical embolectomy for acute pulmonary embolism remain consensus based; however, recent outcomes have improved compared with traditional experiences. This study examined contemporary outcomes of patients treated for acute pulmonary embolism on a nationwide scale.
Patients undergoing systemic thrombolysis, catheter-directed therapy, and surgical embolectomy for acute pulmonary embolism from 2010 to 2014 in the National Inpatient Sample were included.
The study included 58,974 patients with acute pulmonary embolism; of these, 33,553 were treated with systemic thrombolysis, 22,336 with catheter-directed therapy, and 3085 underwent surgical embolectomy. Thrombolysis was the most common, with a substantial increase after 2012, while surgical volumes remained stable. Patients in the surgical group, compared with systemic thrombolysis and catheter-directed therapy, had more saddle emboli (22% vs 10% vs 10%) and were more frequently at severe risk of death (56% vs 42% vs 26%; both P < .01). Surgical embolectomy patients had higher in-hospital mortality (20% vs 16% vs 7%), stroke (7% vs 6% vs 3%), and blood transfusion (32% vs 16% vs 10%; all P < .01). Rates of major bleeding and intracranial hemorrhage were highest in the systemic thrombolysis group. Among surgical patients, age older than 60 years, atrial fibrillation and nonsaddle embolus were associated with increased odds of mortality.
In this contemporary, real-world study, mortality occurred in 19.8% of patients undergoing surgical embolectomy for acute pulmonary embolism. This represents a significant improvement compared with traditional outcomes and supports the role of surgery in the multidisciplinary treatment of this high-risk condition.
概述外科取栓术在急性肺栓塞治疗中作用的指南仍然基于共识；然而，与传统经验相比，最近的结果有所改善。本研究在全国范围内考察了接受急性肺栓塞治疗的患者的当代结局。
纳入 2010 年至 2014 年全国住院患者样本中接受全身溶栓、导管溶栓和外科取栓治疗的急性肺栓塞患者。
本研究纳入 58974 例急性肺栓塞患者；其中 33553 例接受全身溶栓治疗，22336 例接受导管溶栓治疗，3085 例接受外科取栓治疗。溶栓治疗最为常见，2012 年后显著增加，而外科取栓治疗的数量保持稳定。与全身溶栓和导管溶栓相比，外科取栓组患者的鞍状栓塞更多（22%比 10%比 10%），且更频繁地处于严重死亡风险中（56%比 42%比 26%；均 P<.01）。外科取栓患者的住院死亡率（20%比 16%比 7%）、卒中发生率（7%比 6%比 3%）和输血率（32%比 16%比 10%；均 P<.01）更高。全身溶栓组的大出血和颅内出血发生率最高。在外科取栓患者中，年龄大于 60 岁、房颤和非鞍状栓塞与死亡率增加相关。
在这项当代真实世界研究中，接受外科取栓治疗的急性肺栓塞患者死亡率为 19.8%。与传统结局相比，这代表了显著改善，支持手术在这种高危情况下的多学科治疗中的作用。
