Keller Karsten, Schmidt Frank P, Farmakis Ioannis T, Barco Stefano, Fengler Karl, Knorr Maike, Gori Tommaso, Münzel Thomas, Lurz Philipp, Hobohm Lukas
Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
Res Pract Thromb Haemost. 2024 Dec 9;9(1):102651. doi: 10.1016/j.rpth.2024.102651. eCollection 2025 Jan.
Catheter-directed treatment (CDT) is an innovative treatment for patients with elevated risk pulmonary embolism (PE) to resolve embolus and restore pulmonary perfusion.
We aimed to analyse the use and the benefit of CDT in PE patients in Germany.
The German nationwide inpatient sample was used to include all hospitalizations of patients with PE from 2005 to 2020 in Germany. PE patients were stratified for CDT usage. Temporal trends and the impact of CDT on case fatality and other outcomes were investigated.
Overall, 1,373,084 hospitalizations of patients with PE (55.9% aged ≥70 years; 53.0% females) were included in this study from 2005 to 2020, and among these, 427,238 (31.1%) patients were categorized as having elevated-risk PE and 3330 (0.2%) were treated with CDT with annual increase from 0.17% (2005) to 0.51% (2020). PE patients of younger age, male sex, with previous surgery, and elevated-risk PE were more often treated with CDT. In patients with elevated risk-PE, CDT attributed to a lower observed rate of major adverse cardiac and cerebrovascular events (major adverse cardiac and cerebrovascular events [MACCE]; 28.2% vs 34.2%; < .001) and in-hospital case fatality (24.9% vs 31.0%; < .001). CDT was associated with reduced MACCE (OR, 0.91; 95% CI, 0.83-0.99) and with a trend toward lower case fatality (OR, 0.92; 95% CI, 0.84-1.01). The benefit of CDT regarding case fatality was age-dependent.
Although the annual rate of CDT increased in Germany between 2005 and 2020, only 0.2% of the PE patients were treated with CDT. Selection criteria for CDT treatment were younger age, male sex, previous surgery, and elevated risk-PE. CDT treatment was associated with reduced MACCE and case-fatality rate in PE patients with elevated-risk PE.
导管定向治疗（CDT）是一种针对高危肺栓塞（PE）患者的创新治疗方法，用于溶解栓子并恢复肺灌注。
我们旨在分析CDT在德国PE患者中的使用情况和益处。
使用德国全国住院患者样本纳入2005年至2020年德国所有PE患者的住院病例。根据CDT使用情况对PE患者进行分层。研究了时间趋势以及CDT对病死率和其他结局的影响。
总体而言，本研究纳入了2005年至2020年期间1373084例PE患者的住院病例（55.9%年龄≥70岁；53.0%为女性），其中427238例（31.1%）患者被归类为高危PE，3330例（0.2%）接受了CDT治疗，年增长率从2005年的0.17%增至2020年的0.51%。年龄较小、男性、有既往手术史以及高危PE患者更常接受CDT治疗。在高危PE患者中，CDT导致主要不良心脑血管事件（MACCE）的观察发生率较低（MACCE：28.2%对34.2%；P<0.001）以及住院病死率较低（24.9%对31.0%；P<0.001）。CDT与MACCE降低相关（OR，0.91；95%CI，0.83-0.99），且有降低病死率的趋势（OR，0.92；95%CI，0.84-1.01）。CDT对病死率的益处与年龄有关。
尽管2005年至2020年期间德国CDT的年使用率有所增加，但仅0.2%的PE患者接受了CDT治疗。CDT治疗的选择标准为年龄较小、男性、既往手术史以及高危PE。CDT治疗与高危PE患者的MACCE降低和病死率降低相关。
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