Cardiovascular revascularization medicine : including molecular interventions · 2026
Percutaneous embolectomy vs medical therapy for acute pulmonary embolism in patients with cancer.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ang Song Peng, Ram Jaikrishnan, Corban Michel T, Shanmugasundaram Madhan
Аннотация
BACKGROUND: Cancer-associated acute pulmonary embolism (PE) carries high morbidity and mortality, compounded by elevated bleeding risks. While percutaneous therapies are increasingly utilized, robust comparative effectiveness data in this high-risk oncologic population remain scarce.
AIM: To evaluate temporal trends, safety, and clinical outcomes of percutaneous embolectomy versus medical therapy in cancer patients presenting with acute PE.
METHODS: We analyzed the National Inpatient Sample (2016-2021) for adult cancer patients hospitalized with acute PE. Patients were stratified by receipt of percutaneous embolectomy or medical therapy alone. The primary outcome was in-hospital mortality. Propensity-score matching (PSM) (1:3) was utilized to adjust for baseline demographics and hospital characteristics.
RESULTS: Among 476,915 weighted hospitalizations, 2760 (0.6%) underwent percutaneous embolectomy. Utilization increased significantly from 0.16% in 2016 to 1.35% in 2021. The embolectomy cohort exhibited substantially higher baseline clinical acuity, including elevated rates of PE-related shock (46.6% vs 5.2%; P < 0.001). After PSM (n = 11,040), in-hospital mortality did not differ significantly between the percutaneous and medical therapy groups (OR: 0.87; 95% CI: 0.63-1.21). The embolectomy cohort demonstrated similar rates of major bleeding (OR: 0.95; 95% CI: 0.61-1.48) but higher rates of acute kidney injury (OR: 1.36; 95% CI: 1.09-1.71).
CONCLUSIONS: In cancer patients with acute PE, percutaneous embolectomy utilization is rapidly increasing. Despite being performed in a cohort with profound hemodynamic instability, embolectomy was associated with comparable survival and major bleeding rates to medical management.
AIM: To evaluate temporal trends, safety, and clinical outcomes of percutaneous embolectomy versus medical therapy in cancer patients presenting with acute PE.
METHODS: We analyzed the National Inpatient Sample (2016-2021) for adult cancer patients hospitalized with acute PE. Patients were stratified by receipt of percutaneous embolectomy or medical therapy alone. The primary outcome was in-hospital mortality. Propensity-score matching (PSM) (1:3) was utilized to adjust for baseline demographics and hospital characteristics.
RESULTS: Among 476,915 weighted hospitalizations, 2760 (0.6%) underwent percutaneous embolectomy. Utilization increased significantly from 0.16% in 2016 to 1.35% in 2021. The embolectomy cohort exhibited substantially higher baseline clinical acuity, including elevated rates of PE-related shock (46.6% vs 5.2%; P < 0.001). After PSM (n = 11,040), in-hospital mortality did not differ significantly between the percutaneous and medical therapy groups (OR: 0.87; 95% CI: 0.63-1.21). The embolectomy cohort demonstrated similar rates of major bleeding (OR: 0.95; 95% CI: 0.61-1.48) but higher rates of acute kidney injury (OR: 1.36; 95% CI: 1.09-1.71).
CONCLUSIONS: In cancer patients with acute PE, percutaneous embolectomy utilization is rapidly increasing. Despite being performed in a cohort with profound hemodynamic instability, embolectomy was associated with comparable survival and major bleeding rates to medical management.