1st Chair and Department of Cardiology, Medical University of Warsaw, Poland.
Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, Otwock, Poland.
Cardiol J. 2024;31(2):215-225. doi: 10.5603/CJ.a2023.0047. Epub 2023 Jul 31.
Multidisciplinary Pulmonary Embolism Response Teams (PERTs) were established to individualize the treatment of high-risk (HR) and intermediate-high-risk (IHR) pulmonary embolism (PE) patients, which pose a challenge in clinical practice.
We retrospectively collected the data of all HR and IHR acute PE patients consulted by PERT CELZAT between September 2017 and October 2022. The patient population was divided into four different treatment methods: anticoagulation alone (AC), systemic thrombolysis (ST), surgical embolectomy (SE), and catheter-directed therapies (CDTx). Baseline clinical characteristics, risk stratification, PE severity parameters, and treatment outcomes were compared between the four groups.
Of the 110 patients with HR and IHR PE, 67 (61%) patients were treated with AC only, 11 (10%) with ST, 15 (14%) underwent SE, and 17 (15%) were treated with CTDx. The most common treatment option in the HR group was reperfusion therapy, used in 20/24 (83%) cases, including ST in 7 (29%) patients, SE in 5 (21%) patients, and CTDx in 8 (33%) patients. In contrast, IHR patients were treated with AC alone in 63/86 (73%) cases. The in-hospital mortality rate was 9/24 (37.5%) in the HR group and 4/86 (4.7%) in the IHR group.
The number of advanced procedures aimed at reperfusion was substantially higher in the HR group than in the IHR PE group. Despite the common use of advanced reperfusion techniques in the HR group, patient mortality remained high. There is a need further to optimize the treatment of patients with HR PE to improve outcomes.
多学科肺栓塞反应团队（PERT）的建立是为了针对高危（HR）和中高危（IHR）肺栓塞（PE）患者进行个体化治疗，这在临床实践中带来了挑战。
我们回顾性收集了 2017 年 9 月至 2022 年 10 月期间由 PERT CELZAT 咨询的所有 HR 和 IHR 急性 PE 患者的数据。将患者人群分为四种不同的治疗方法：单独抗凝（AC）、全身溶栓（ST）、手术取栓（SE）和导管定向治疗（CDTx）。比较了四组之间的基线临床特征、风险分层、PE 严重程度参数和治疗结果。
在 110 例 HR 和 IHR PE 患者中，67 例（61%）患者仅接受 AC 治疗，11 例（10%）接受 ST 治疗，15 例（14%）接受 SE 治疗，17 例（15%）接受 CTDx 治疗。HR 组最常见的治疗选择是再灌注治疗，24 例中有 20 例（83%）采用该治疗，包括 7 例（29%）接受 ST 治疗，5 例（21%）接受 SE 治疗，8 例（33%）接受 CTDx 治疗。相比之下，IHR 患者中有 86 例中的 63 例（73%）接受 AC 单独治疗。HR 组的住院死亡率为 9/24（37.5%），IHR 组为 4/86（4.7%）。
与 IHR PE 组相比，HR 组用于再灌注的高级治疗方法数量明显更多。尽管 HR 组普遍使用高级再灌注技术，但患者死亡率仍然很高。需要进一步优化 HR PE 患者的治疗方法，以改善治疗结果。
