Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA.
Premier Cardiovascular Institute, Dayton, OH, USA.
J Cardiol. 2022 Nov;80(5):441-448. doi: 10.1016/j.jjcc.2022.04.008. Epub 2022 May 25.
Patients with submassive pulmonary embolism (PE) are vulnerable to sudden deterioration, recurrent PE, and progression to pulmonary hypertension and chronic right ventricular (RV) dysfunction. Previous studies have suggested a clinical benefit of using ultrasound-assisted catheter-directed thrombolysis (USCDT) to invasively manage patients with submassive PE. However, there is sparse data comparing the clinical outcomes of these patients when treated with USCDT versus anticoagulation (AC) alone. We sought to compare the outcomes of USCDT versus AC alone in the management of submassive PE.
192 consecutive patients who underwent USCDT for submassive PE between January 2013 and February 2019 were identified. ICD9/ICD10 codes were used to detect 2554 patients diagnosed with PE who did not undergo thrombolysis. Propensity matching identified 192 patients with acute PE treated with AC alone. Clinical outcomes were compared between the two groups. Baseline demographics, laboratory values, and pulmonary embolism severity index scores were similar between the two cohorts.
There was a significant reduction in mean systolic pulmonary artery pressure (sPAP) in the USCDT group compared to the AC group (∆11 vs ∆3.9 mmHg, p < 0.001). There was significant improvement in proportion of RV dysfunction in all patients, but the difference was larger in the USCDT group (∆43.3% vs ∆17.3%, p < 0.001). Patients who underwent USCDT had lower 30-day (4.3% vs 10.5%, p = 0.03), 90-day (5.5% vs 12.4%, p = 0.03), and 1-year mortality (6.2% vs 14.2%, p = 0.03).
In patients with acute submassive PE, USCDT was associated with improved 30-day, 90-day, and 1 year mortality as compared to AC alone. USCDT also improved RV function and reduced sPAP to a greater degree than AC alone. Further studies are needed to verify these results in both short- and long-term outcomes.
亚大块肺栓塞（PE）患者易发生突然恶化、复发性 PE 以及进展为肺动脉高压和慢性右心室（RV）功能障碍。先前的研究表明，超声引导下导管溶栓（USCDT）治疗亚大块 PE 患者具有临床益处。然而，关于 USCDT 与单独抗凝（AC）治疗这些患者的临床结局比较的数据甚少。我们旨在比较 USCDT 与单独 AC 治疗亚大块 PE 的结局。
192 例于 2013 年 1 月至 2019 年 2 月期间因亚大块 PE 行 USCDT 的连续患者被识别。使用 ICD9/ICD10 编码检测 2554 例未行溶栓治疗的 PE 患者。倾向匹配识别出 192 例急性 PE 患者接受单独 AC 治疗。比较两组的临床结局。两组间的基线人口统计学、实验室值和肺栓塞严重指数评分相似。
与 AC 组相比，USCDT 组的平均收缩肺动脉压（sPAP）显著降低（∆11 与 ∆3.9mmHg，p<0.001）。所有患者的 RV 功能障碍比例均显著改善，但 USCDT 组的改善程度更大（∆43.3%与 ∆17.3%，p<0.001）。行 USCDT 的患者 30 天（4.3%与 10.5%，p=0.03）、90 天（5.5%与 12.4%，p=0.03）和 1 年死亡率（6.2%与 14.2%，p=0.03）均较低。
与单独 AC 治疗相比，急性亚大块 PE 患者行 USCDT 治疗与 30 天、90 天和 1 年死亡率降低相关。USCDT 还改善 RV 功能并降低 sPAP 的程度大于单独 AC 治疗。需要进一步的研究来验证这些结果在短期和长期结局中的表现。
