The Canadian journal of cardiology · 2026
Outcomes of High-Risk Pulmonary Embolism Stratified According to Clinical Phenotype: Results From 2 Specialized Pulmonary Embolism Centres.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Stępniewski Jakub, Sławek-Szmyt Sylwia, Karnaś Michał, Chaba-Karnaś Weronika, Kurczyna Patrycja, Magoń Wojciech, Jonas Kamil, Waligóra Marcin, Araszkiewicz Aleksander, Kopeć Grzegorz
Аннотация
BACKGROUND: High-risk pulmonary embolism (HR-PE) includes a heterogeneous population ranging from cardiac arrest to obstructive shock or hypotension, with high early mortality. Although systemic thrombolysis (ST) remains the standard of care, its use is limited by contraindications and bleeding risk. Catheter-directed therapies (CDTs) have emerged as alternatives, although data in the HR-PE population are limited. In this study we aimed to assess clinical characteristics, management, and outcomes across 3 HR-PE clinical phenotypes.
METHODS: We analyzed 137 consecutive HR-PE patients consulted by 2 Polish pulmonary embolism response team centres. On the basis of presentation, patients were stratified into 3 groups: cardiac arrest, shock, and hypotension, according to the European Society of Cardiology HR-PE criteria. Reperfusion strategies included ST and CDT. The primary outcome was in-hospital mortality. Logistic regression was used to identify predictors of survival.
RESULTS: In-hospital mortality differed significantly across phenotypes (cardiac arrest: 40.0%; shock: 21.1%; hypotension: 8.7%; P = 0.01). CDT was associated with lower mortality than ST (6.7% vs 41.1%,; P < 0.001), especially in the shock (6.3% vs 38.1%; P = 0.009) and hypotension groups (0% vs 25.0%; P = 0.04). CDT was also linked to fewer major bleeding events and less therapy failure. Management at an expert pulmonary embolism (PE) centre was associated with improved survival, particularly among cardiac arrest patients, whereas the use of CDT determined survival in HR-PE patients with shock or hypotension.
CONCLUSIONS: HR-PE patients presented phenotype-specific differences in prognosis and treatment response. Our findings support a phenotype-driven approach and timely referral to expert PE centres, where CDT might be a safer and more effective alternative to ST particularly in non-cardiac-arrest PE patients.
METHODS: We analyzed 137 consecutive HR-PE patients consulted by 2 Polish pulmonary embolism response team centres. On the basis of presentation, patients were stratified into 3 groups: cardiac arrest, shock, and hypotension, according to the European Society of Cardiology HR-PE criteria. Reperfusion strategies included ST and CDT. The primary outcome was in-hospital mortality. Logistic regression was used to identify predictors of survival.
RESULTS: In-hospital mortality differed significantly across phenotypes (cardiac arrest: 40.0%; shock: 21.1%; hypotension: 8.7%; P = 0.01). CDT was associated with lower mortality than ST (6.7% vs 41.1%,; P < 0.001), especially in the shock (6.3% vs 38.1%; P = 0.009) and hypotension groups (0% vs 25.0%; P = 0.04). CDT was also linked to fewer major bleeding events and less therapy failure. Management at an expert pulmonary embolism (PE) centre was associated with improved survival, particularly among cardiac arrest patients, whereas the use of CDT determined survival in HR-PE patients with shock or hypotension.
CONCLUSIONS: HR-PE patients presented phenotype-specific differences in prognosis and treatment response. Our findings support a phenotype-driven approach and timely referral to expert PE centres, where CDT might be a safer and more effective alternative to ST particularly in non-cardiac-arrest PE patients.