Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Internal Medicine, Berkshire Medical Center, Pittsfield, MA, USA.
Perfusion. 2023 Sep;38(6):1123-1132. doi: 10.1177/02676591221108811. Epub 2022 Jun 20.
Acute submassive a massive pulmonary embolism are known as leading causes of cardiovascular morbidity and mortality in emergency departments. Choosing the optimal type of catheter directed thrombolysis (CDT) for treatment of pulmonary embolism presents a quandary to the practitioners. To the best of our knowledge, there is no meta-analysis comparing superiority of conventional CDT and ultrasound-accelerated catheter directed thrombolysis (USACDT). Therefore, in this meta-analysis, we aimed to compare conventional CDT with USACDT regarding clinical outcomes and safety profile.
A systematic literature search of previous published studies comparing conventional CDT with USACDT regarding clinical outcomes and safety profile was carried out in the electronic databases including MEDLINE, Scopus, EBSCO, Google Scholar, Web of Science, and Cochrane from inception to December 2021. Data were analyzed by comprehensive meta-analysis software (CMA, version 3).
The meta-analysis included nine studies with a total of 705 patients. Our meta-analysis showed that there is no significant difference between two groups with respect to pulmonary arterial systolic pressure (SMD: -0.084; 95% CI: -0.287 to 0.12; : 0.41), RV/LV (SMD: -0.003; 95% CI: -0.277 to 0.270; : 0.98), and Miller score (SMD: -0.345; 95% CI: -1.376 to 0.686; : 0.51). Similarly, we found no statistically significant differences between two groups regarding major and minor bleeding ( > .05).
Our meta-analysis showed that when compared with USACDT, conventional CDT provides similar clinical and hemodynamic outcomes or safety for treatment of pulmonary embolism without the need for very expensive technologies. However, randomized clinical trials are required to further investigate cost-effectiveness of USACDT in comparison with conventional CDT.
急性亚大块型和大块型肺栓塞是急诊科心血管发病率和死亡率的主要原因。选择最佳的导管直接溶栓（CDT）类型治疗肺栓塞对医生来说是一个难题。据我们所知，目前还没有比较传统 CDT 和超声加速导管直接溶栓（USACDT）优越性的荟萃分析。因此，在本荟萃分析中，我们旨在比较传统 CDT 与 USACDT 在临床结果和安全性方面的差异。
我们在电子数据库中进行了系统的文献检索，检索了自成立以来至 2021 年 12 月比较传统 CDT 与 USACDT 在临床结果和安全性方面的研究，包括 MEDLINE、Scopus、EBSCO、Google Scholar、Web of Science 和 Cochrane。数据由综合荟萃分析软件（CMA，版本 3）进行分析。
荟萃分析纳入了 9 项共 705 例患者的研究。我们的荟萃分析显示，两组患者在肺动脉收缩压（SMD：-0.084；95%CI：-0.287 至 0.12；：0.41）、RV/LV（SMD：-0.003；95%CI：-0.277 至 0.270；：0.98）和 Miller 评分（SMD：-0.345；95%CI：-1.376 至 0.686；：0.51）方面均无显著差异。同样，两组在大出血和小出血方面也无统计学差异（>0.05）。
本荟萃分析表明，与 USACDT 相比，传统 CDT 为治疗肺栓塞提供了相似的临床和血液动力学结果或安全性，而无需昂贵的技术。然而，需要随机临床试验来进一步研究 USACDT 与传统 CDT 相比的成本效益。
