Cardiovascular revascularization medicine : including molecular interventions · 2026
In-hospital outcomes of catheter-directed therapies for pulmonary embolism in the United States 2016-2022.
СтатьяНазвание и аннотация: Перевод в очереди
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Sheffeh Mohammad Ali, Gregory Andrew, Gallagher John, Moyal Joshua, Sheffeh Judy, Kailouh Diana, Oujamaa Ider, Fahed Joud, Soukas Peter A, Alraies M Chadi, Goldsweig Andrew M
Аннотация
BACKGROUND: Mechanical thrombectomy (MT) and catheter-directed thrombolysis (CDT) are treatments for pulmonary embolism (PE), but their recent utilization and relative outcomes are unclear. We evaluated the most recent utilization trends and compared the in-hospital outcomes of MT and CDT.
METHODS: We queried the National Inpatient Sample database to identify adults with a primary diagnosis of PE undergoing either MT or CDT between 2016 and 2022. We excluded those <18 years or undergoing both MT and CDT, surgical thrombectomy, or systemic thrombolysis. Poisson regression models were used to evaluate temporal trends, and multivariate logistic regression models were used to test the association between in-hospital outcomes of MT and CDT.
RESULTS: Among 71,175 patients with PE, 32,465 (45.6%) underwent MT, and 38,710 (54.4%) underwent CDT. Utilization of MT increased significantly with an annual percent change (APC) of 68.1% (95% CI, 65.9%-70.5%; p < 0.0001). By contrast, CDT showed a steady decline, with an APC of -0.9% (95% CI, -1.7% to -0.2%; p < 0.0001). MT had higher in-hospital mortality than CDT (5% vs 3% adjusted odds ratio [aOR] 2.12, 95% CI 1.93-2.33; p < 0.0001). MT was also associated with increased risk of mechanical ventilation, ECMO, Impella use, bleeding complications, palliative consult, and DNR status, p for all <0.0001.
CONCLUSIONS: This study shows a significant shift in the catheter-directed therapies for PE in the U.S. The use of MT increased between 2016 and 2022 and shows improved clinical outcomes over the years.
METHODS: We queried the National Inpatient Sample database to identify adults with a primary diagnosis of PE undergoing either MT or CDT between 2016 and 2022. We excluded those <18 years or undergoing both MT and CDT, surgical thrombectomy, or systemic thrombolysis. Poisson regression models were used to evaluate temporal trends, and multivariate logistic regression models were used to test the association between in-hospital outcomes of MT and CDT.
RESULTS: Among 71,175 patients with PE, 32,465 (45.6%) underwent MT, and 38,710 (54.4%) underwent CDT. Utilization of MT increased significantly with an annual percent change (APC) of 68.1% (95% CI, 65.9%-70.5%; p < 0.0001). By contrast, CDT showed a steady decline, with an APC of -0.9% (95% CI, -1.7% to -0.2%; p < 0.0001). MT had higher in-hospital mortality than CDT (5% vs 3% adjusted odds ratio [aOR] 2.12, 95% CI 1.93-2.33; p < 0.0001). MT was also associated with increased risk of mechanical ventilation, ECMO, Impella use, bleeding complications, palliative consult, and DNR status, p for all <0.0001.
CONCLUSIONS: This study shows a significant shift in the catheter-directed therapies for PE in the U.S. The use of MT increased between 2016 and 2022 and shows improved clinical outcomes over the years.