Department of Internal Medicine and Cardiology, Medical University of Warsaw, Poland.
Clinic of Cardiology, Military Medical Academy, Belgrade, Serbia.
Cardiol J. 2024;31(3):390-397. doi: 10.5603/cj.95949. Epub 2023 Sep 29.
Catheter directed therapies (CDT) are widely used in the treatment of acute pulmonary embolism (PE). A multicenter registry was organized to evaluate their application in real life and to determine efficacy and safety of these procedures. Local experience of participating centers in percutaneous techniques for PE treatment was assessed.
An internet-based registry was designed to collect clinical, echocardiographic and laboratory data of consecutive PE patients treated with CDT in participating centers between 2017 and 2022.
Under analysis were 145 consecutive patients with acute PE, aged 61 ± 15 years, treated with CDT in 7 centers: 50 (34.5%) patients with high-risk PE (HRPE), and 95 (65.5%) patients with intermediate-high risk PE (IHRPE). 100 (69%) patients were treated with dedicated devices, in 45 (31%) subjects a pigtail catheter was used. Total PE or CDT related in-hospital mortality in HRPE reached 14% (7 patients), while in IHRPE 3.2% (3 patients) (p = 0.032). 50% of PE or CDT related deaths occurred in patients treated with a pigtail catheter. All-cause mortality in 145 patients was 9.7%, and it was higher in HRPE than in IHRPE (18% vs. 5.3%, p = 0.019). The use of pigtail catheters compared to dedicated systems was associated with higher mortality (20% vs. 5%, p = 0.01).
Catheter directed therapies is a real option of treating PE. It was used as primary therapy also in patients without contraindication for thrombolysis suggesting that clinical practice does not always follow current PE guidelines. Patients treated with dedicated CDT systems had a higher survival rate than subjects treated with pigtail catheters.
导管介入治疗（CDT）广泛应用于急性肺栓塞（PE）的治疗。本多中心注册研究旨在评估其在真实世界中的应用，并确定这些治疗方法的疗效和安全性。评估了参与中心在经皮PE 治疗中的经皮技术的本地经验。
设计了一个基于互联网的注册研究，以收集 2017 年至 2022 年间参与中心用 CDT 治疗的连续 PE 患者的临床、超声心动图和实验室数据。
共分析了 145 例连续的急性 PE 患者，年龄 61 ± 15 岁，在 7 个中心接受 CDT 治疗：50 例（34.5%）为高危 PE（HRPE），95 例（65.5%）为中高危 PE（IHRPE）。100 例（69%）患者接受专用设备治疗，45 例（31%）患者使用猪尾导管。HRPE 中总 PE 或 CDT 相关院内死亡率达到 14%（7 例），而 IHRPE 中为 3.2%（3 例）（p = 0.032）。50%的 PE 或 CDT 相关死亡发生在使用猪尾导管治疗的患者中。145 例患者的全因死亡率为 9.7%，HRPE 高于 IHRPE（18% vs. 5.3%，p = 0.019）。与专用系统相比，使用猪尾导管与更高的死亡率相关（20% vs. 5%，p = 0.01）。
导管介入治疗是治疗 PE 的一种现实选择。即使对于无溶栓禁忌证的患者，也将其作为一线治疗方法，这表明临床实践并不总是遵循当前的 PE 指南。与使用猪尾导管的患者相比，使用专用 CDT 系统的患者存活率更高。
