Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
Division of Cardiovascular Diseases, Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
J Vasc Surg Venous Lymphat Disord. 2024 May;12(3):101823. doi: 10.1016/j.jvsv.2024.101823. Epub 2024 Feb 16.
Major progress in reperfusion strategies has substantially improved the short-term outcomes of patients with pulmonary embolism (PE), however, up to 50% of patients report persistent dyspnea after acute PE.
A retrospective study of the PE response team registry and included patients with repeat imaging at 3 to 12 months. The primary outcome was to determine the incidence of residual pulmonary vascular obstruction following acute PE. Secondary outcomes included the development of PE recurrence, right ventricular (RV) dysfunction, chronic thromboembolic pulmonary hypertension, readmission, and mortality at 12 months.
A total of 382 patients were included, and 107 patients received reperfusion therapies followed by anticoagulation. Patients who received reperfusion therapies including systemic thrombolysis, catheter-directed thrombolysis, and mechanical thrombectomy presented with a higher vascular obstructive index (47% vs 28%; P < .001) and signs of right heart strain on echocardiogram (81% vs 43%; P < .001) at the time of diagnosis. A higher absolute reduction in vascular obstructive index (45% vs 26%; 95% confidence interval, 14.0-25.6; P < .001), greater improvement in RV function (82% vs 65%; P = .021), and lower 12-month mortality rate (2% vs 7%; P = .038) and readmission rate (33% vs 46%; P = .031) were observed in the reperfusion group. No statistically significant differences were found between groups in the development of chronic thromboembolic pulmonary hypertension (8% vs 5%; P = .488) and PE recurrence (8% vs 6%; P = .646).
We observed a favorable survival and greater improvement in clot resolution and RV function in patients treated with reperfusion therapies.
再灌注策略的重大进展显著改善了肺栓塞（PE）患者的短期预后，但多达 50%的患者在急性 PE 后仍持续存在呼吸困难。
对 PE 反应团队登记处进行回顾性研究，纳入了在 3 至 12 个月时进行重复影像学检查的患者。主要结局是确定急性 PE 后肺血管阻塞的发生率。次要结局包括 PE 复发、右心室（RV）功能障碍、慢性血栓栓塞性肺动脉高压、再入院和 12 个月时的死亡率。
共纳入 382 例患者，其中 107 例接受再灌注治疗后再接受抗凝治疗。接受再灌注治疗（包括全身溶栓、导管溶栓和机械血栓切除术）的患者在诊断时的血管阻塞指数（47%比 28%；P<0.001）和超声心动图上右心应变迹象（81%比 43%；P<0.001）更高。血管阻塞指数的绝对减少幅度更大（45%比 26%；95%置信区间，14.0-25.6；P<0.001），RV 功能改善更大（82%比 65%；P=0.021），再入院率（33%比 46%；P=0.031）和 12 个月死亡率（2%比 7%；P=0.038）较低在再灌注组。两组在慢性血栓栓塞性肺动脉高压（8%比 5%；P=0.488）和 PE 复发（8%比 6%；P=0.646）的发生率方面无统计学差异。
我们观察到接受再灌注治疗的患者的存活率较高，血栓溶解和 RV 功能改善更大。
