Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY 10016, USA.
Division of Cardiology, Penn Presbyterian Medical Center, Philadelphia, PA, USA.
Eur Heart J. 2024 Jun 7;45(22):1988-1998. doi: 10.1093/eurheartj/ehae184.
Catheter-based therapies (CBTs) have been developed as a treatment option in patients with pulmonary embolism (PE). There remains a paucity of data to inform decision-making in patients with intermediate-risk or high-risk PE. The aim of this study was to characterize in-hospital and readmission outcomes in patients with intermediate-risk or high-risk PE treated with vs. without CBT in a large retrospective registry.
Patients hospitalized with intermediate-risk or high-risk PE were identified using the 2017-20 National Readmission Database. In-hospital outcomes included death and bleeding and 30- and 90-day readmission outcomes including all-cause, venous thromboembolism (VTE)-related and bleeding-related readmissions. Inverse probability of treatment weighting (IPTW) was utilized to compare outcomes between CBT and no CBT.
A total of 14 903 [2076 (13.9%) with CBT] and 42 829 [8824 (20.6%) with CBT] patients with high-risk and intermediate-risk PE were included, respectively. Prior to IPTW, patients with CBT were younger and less likely to have cancer and cardiac arrest, receive systemic thrombolysis, or be on mechanical ventilation. In the IPTW logistic regression model, CBT was associated with lower odds of in-hospital death in high-risk [odds ratio (OR) 0.83, 95% confidence interval (CI) 0.80-0.87] and intermediate-risk PE (OR 0.76, 95% CI 0.70-0.83). Patients with high-risk PE treated with CBT were associated with lower risk of 90-day all-cause [hazard ratio (HR) 0.77, 95% CI 0.71-0.83] and VTE (HR 0.46, 95% CI 0.34-0.63) readmission. Patients with intermediate-risk PE treated with CBT were associated with lower risk of 90-day all-cause (HR 0.75, 95% CI 0.72-0.79) and VTE (HR 0.66, 95% CI 0.57-0.76) readmission.
Among patients with high-risk or intermediate-risk PE, CBT was associated with lower in-hospital death and 90-day readmission. Prospective, randomized trials are needed to confirm these findings.
经导管治疗（CBT）已作为肺栓塞（PE）患者的一种治疗选择得到发展。对于中危或高危 PE 患者，仍然缺乏数据来为决策提供信息。本研究的目的是在大型回顾性登记处中，描述接受与不接受 CBT 治疗的中危或高危 PE 患者的住院和再入院结局。
使用 2017-20 年国家再入院数据库确定中危或高危 PE 住院患者。住院期间的结局包括死亡和出血，30 天和 90 天的再入院结局包括全因、静脉血栓栓塞（VTE）相关和出血相关再入院。采用逆概率治疗加权（IPTW）比较 CBT 和无 CBT 之间的结局。
共纳入 14903 例（2076 例接受 CBT）和 42829 例（8824 例接受 CBT）高危和中危 PE 患者。在进行 IPTW 之前，接受 CBT 的患者年龄较小，癌症和心脏骤停、接受全身溶栓或机械通气的可能性较低。在 IPTW 逻辑回归模型中，CBT 与高危 [比值比（OR）0.83，95%置信区间（CI）0.80-0.87] 和中危 PE 住院期间死亡的可能性降低相关[OR 0.76，95%CI 0.70-0.83]。接受 CBT 治疗的高危 PE 患者 90 天全因 [风险比（HR）0.77，95%CI 0.71-0.83] 和 VTE [HR 0.46，95%CI 0.34-0.63] 再入院的风险较低。接受 CBT 治疗的中危 PE 患者 90 天全因 [HR 0.75，95%CI 0.72-0.79] 和 VTE [HR 0.66，95%CI 0.57-0.76] 再入院的风险较低。
在高危或中危 PE 患者中，CBT 与住院期间死亡和 90 天再入院风险降低相关。需要前瞻性、随机试验来证实这些发现。
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