Catheter-based interventions versus medical and surgical approaches in acute pulmonary embolism.
Anticoagulation
Catheter-based therapies
Pulmonary embolism
Surgical pulmonary embolectomy
Journal
Journal of vascular surgery. Venous and lymphatic disorders
ISSN: 2213-3348
Titre abrégé: J Vasc Surg Venous Lymphat Disord
Pays: United States
ID NLM: 101607771
Informations de publication
Date de publication:
11 2021
11 2021
Historique:
received:
17
11
2020
accepted:
21
02
2021
pubmed:
10
5
2021
medline:
4
3
2022
entrez:
9
5
2021
Statut:
ppublish
Résumé
Catheter-based intervention (CBI) has become an increasingly popular option for treating pulmonary embolism (PE); however, the real benefits are unknown. The purpose of the present study was to compare the outcomes of patients treated with CBI with the outcomes of those treated with medical or surgical approaches. We performed a retrospective analysis of patients admitted from October 2015 to December 2017 with a diagnosis of acute PE. We compared patients aged ≥18 years with a diagnosis of acute PE treated with CBI against a control group identified by propensity score matching. The control group was divided into those who had undergone surgical pulmonary embolectomy (SPE) as the surgical group and those who had not undergone SPE as the medical group. The primary outcome was mortality (in-hospital and overall mortality). The secondary outcomes were major bleeding, length of hospital stay, thrombus resolution, right ventricle improvement in systolic function and dilatation, and recurrent PE. Of the 108 patients, 30 were in the CBI group and 78 were in the control group (62 in the medical group and 16 in the surgical group). The patient characteristics on admission were similar, except for the body mass index, which was greater in the CBI group (P = .03). No difference was found in clinical severity, clot burden, right ventricle function, or biomarkers. Recurrent PE was less frequent in the CBI group than in the medical group (0% vs 6.4%). Otherwise, no significant differences were found in the outcomes between the CBI and medical groups. When CBI was compared with the surgical group, SPE was associated with improved mortality (0% vs 16.6%) but a longer median length of hospital stay (median, 7 days; interquartile range, 3-12 days; vs median, 8 days; interquartile range, 6.5-17 days). The use of CBI reduced the number of recurrent PE events compared with the medically treated patients; however, the mortality was higher than that in the surgical group.
Identifiants
pubmed: 33965609
pii: S2213-333X(21)00101-3
doi: 10.1016/j.jvsv.2021.02.015
pmc: PMC9048149
mid: NIHMS1781832
pii:
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1382-1390Subventions
Organisme : NINDS NIH HHS
ID : U01 NS080168
Pays : United States
Organisme : NIA NIH HHS
ID : P30 AG028747
Pays : United States
Organisme : CSRD VA
ID : I01 CX001621
Pays : United States
Organisme : NIDDK NIH HHS
ID : P30 DK072488
Pays : United States
Organisme : RRD VA
ID : I01 RX000995
Pays : United States
Informations de copyright
Copyright © 2021 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.
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