Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing.
Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing.
Am J Med. 2021 Oct;134(10):1260-1264. doi: 10.1016/j.amjmed.2021.01.026. Epub 2021 Feb 22.
Several advanced treatments of high-risk patients with pulmonary embolism have been used in recent decades. We assessed the 19-year national trend in mortality of high-risk patients with pulmonary embolism to determine what impact, if any, advanced therapy might have had on mortality.
Mortality (case fatality rate) was assessed in patients with a primary (first-listed) diagnosis of high-risk pulmonary embolism who were hospitalized during the period from 1999 to 2014 and in 2016 and 2017. High-risk was defined as patients with pulmonary embolism who were in shock or suffered cardiac arrest. International Classification of Diseases, 9th revision, Clinical Modification codes were used for data on the period from 1999 to 2014, and version 10 codes were used for data on the years 2016 and 2017. Trends in mortality were assessed according to treatment.
From 1999 to 2017 (excluding 2015), 58,784 patients were hospitalized in United States with a primary diagnosis of pulmonary embolism that was high risk. Mortality in all high-risk patients decreased from 72.7% in 1999 to 49.8% in 2017 (P < .0001). Most high-risk patients (60.3%) were treated with anticoagulants alone and did not receive an inferior vena cava filter. Mortality in these patients decreased from 79.0% in 1999 to 55.7% in 2017 (P < .0001). Thrombolytic therapy was administered to 16.1% of high-risk patients, open pulmonary embolectomy alone was used in 4.3%, and extracorporeal membrane oxygenation was used in 0.4%.
Mortality of high-risk patients with pulmonary embolism has decreased. This decrease can be attributed to improved treatment of patients with shock and with cardiac arrest, and does not reflect advances in therapy for pulmonary embolism.
近几十年来，已经有几种针对高危肺栓塞患者的先进治疗方法得到应用。我们评估了 19 年来高危肺栓塞患者死亡率的国家趋势，以确定先进治疗方法是否对死亡率产生了影响。
评估了 1999 年至 2014 年期间以及 2016 年和 2017 年期间因原发性（首次列出）高危肺栓塞住院的患者的死亡率（病死率）。高危定义为有休克或心脏骤停的肺栓塞患者。1999 年至 2014 年期间使用国际疾病分类第 9 版临床修订版代码，2016 年和 2017 年期间使用第 10 版代码。根据治疗方法评估死亡率趋势。
1999 年至 2017 年（不包括 2015 年），美国有 58784 例因原发性肺栓塞而住院的高危患者。所有高危患者的死亡率从 1999 年的 72.7%降至 2017 年的 49.8%（P<0.0001）。大多数高危患者（60.3%）单独接受抗凝治疗，未接受下腔静脉滤器。这些患者的死亡率从 1999 年的 79.0%降至 2017 年的 55.7%（P<0.0001）。溶栓治疗用于 16.1%的高危患者，单独使用肺动脉血栓切除术用于 4.3%的患者，体外膜肺氧合用于 0.4%的患者。
高危肺栓塞患者的死亡率已下降。这种下降可归因于对休克和心脏骤停患者治疗的改善，而不是反映肺栓塞治疗的进步。
