经导管介入治疗与急性肺栓塞的药物及手术治疗。
Catheter-based interventions versus medical and surgical approaches in acute pulmonary embolism.
机构信息
Department of Surgery, University of Maryland School of Medicine, Baltimore, Md; Department of Medicine, University of Maryland School of Medicine, Baltimore, Md.
Department of Surgery, University of Maryland School of Medicine, Baltimore, Md.
出版信息
J Vasc Surg Venous Lymphat Disord. 2021 Nov;9(6):1382-1390. doi: 10.1016/j.jvsv.2021.02.015. Epub 2021 May 7.
OBJECTIVE
Catheter-based intervention (CBI) has become an increasingly popular option for treating pulmonary embolism (PE); however, the real benefits are unknown. The purpose of the present study was to compare the outcomes of patients treated with CBI with the outcomes of those treated with medical or surgical approaches.
METHODS
We performed a retrospective analysis of patients admitted from October 2015 to December 2017 with a diagnosis of acute PE. We compared patients aged ≥18 years with a diagnosis of acute PE treated with CBI against a control group identified by propensity score matching. The control group was divided into those who had undergone surgical pulmonary embolectomy (SPE) as the surgical group and those who had not undergone SPE as the medical group. The primary outcome was mortality (in-hospital and overall mortality). The secondary outcomes were major bleeding, length of hospital stay, thrombus resolution, right ventricle improvement in systolic function and dilatation, and recurrent PE.
RESULTS
Of the 108 patients, 30 were in the CBI group and 78 were in the control group (62 in the medical group and 16 in the surgical group). The patient characteristics on admission were similar, except for the body mass index, which was greater in the CBI group (P = .03). No difference was found in clinical severity, clot burden, right ventricle function, or biomarkers. Recurrent PE was less frequent in the CBI group than in the medical group (0% vs 6.4%). Otherwise, no significant differences were found in the outcomes between the CBI and medical groups. When CBI was compared with the surgical group, SPE was associated with improved mortality (0% vs 16.6%) but a longer median length of hospital stay (median, 7 days; interquartile range, 3-12 days; vs median, 8 days; interquartile range, 6.5-17 days).
CONCLUSIONS
The use of CBI reduced the number of recurrent PE events compared with the medically treated patients; however, the mortality was higher than that in the surgical group.
目的
经导管介入治疗（CBI）已成为治疗肺栓塞（PE）的一种越来越受欢迎的选择；然而，其实际益处尚不清楚。本研究的目的是比较 CBI 治疗患者的结局与接受药物或手术治疗患者的结局。
方法
我们对 2015 年 10 月至 2017 年 12 月期间因急性 PE 入院的患者进行了回顾性分析。我们比较了年龄≥18 岁的接受 CBI 治疗的急性 PE 患者与通过倾向评分匹配确定的对照组。对照组分为接受手术肺动脉血栓切除术（SPE）的手术组和未接受 SPE 的药物组。主要结局是死亡率（住院期间和总体死亡率）。次要结局包括大出血、住院时间、血栓溶解、右心室收缩功能和扩张改善以及复发性 PE。
结果
在 108 例患者中，30 例患者接受 CBI 治疗，78 例患者接受对照组治疗（药物组 62 例，手术组 16 例）。入院时患者特征相似，除了 CBI 组的体重指数较大（P=0.03）。临床严重程度、血栓负荷、右心室功能或生物标志物无差异。CBI 组复发性 PE 发生率低于药物组（0% vs 6.4%）。此外，CBI 组与药物组的结局无显著差异。与手术组相比，SPE 与死亡率降低（0% vs 16.6%）相关，但中位住院时间较长（中位数，7 天；四分位距，3-12 天；中位数，8 天；四分位距，6.5-17 天）。
结论
与药物治疗的患者相比，CBI 的使用减少了复发性 PE 事件的发生，但死亡率高于手术组。
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