A retrospective analysis of catheter-based thrombolytic therapy for acute submassive and massive pulmonary embolism
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作者:
George, Bennet
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Univ Kentucky, Gill Heart Inst, Div Cardiovasc Med, Lexington, KY 40536 USAUniv Kentucky, Gill Heart Inst, Div Cardiovasc Med, Lexington, KY 40536 USA
George, Bennet
[1
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Wallace, Eric L.
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Univ Kentucky, Gill Heart Inst, Div Cardiovasc Med, Lexington, KY 40536 USAUniv Kentucky, Gill Heart Inst, Div Cardiovasc Med, Lexington, KY 40536 USA
Wallace, Eric L.
[1
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Charnigo, Richard
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Univ Kentucky, Sch Publ Hlth, Lexington, KY 40536 USAUniv Kentucky, Gill Heart Inst, Div Cardiovasc Med, Lexington, KY 40536 USA
Charnigo, Richard
[2
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Wingerter, Kelly E.
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Univ Kentucky, Dept Internal Med, Lexington, KY 40536 USAUniv Kentucky, Gill Heart Inst, Div Cardiovasc Med, Lexington, KY 40536 USA
Wingerter, Kelly E.
[3
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Kapadia, Pavan
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Univ Kentucky, Dept Internal Med, Lexington, KY 40536 USAUniv Kentucky, Gill Heart Inst, Div Cardiovasc Med, Lexington, KY 40536 USA
Kapadia, Pavan
[3
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Gurley, John C.
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Univ Kentucky, Gill Heart Inst, Div Cardiovasc Med, Lexington, KY 40536 USAUniv Kentucky, Gill Heart Inst, Div Cardiovasc Med, Lexington, KY 40536 USA
Gurley, John C.
[1
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Smyth, Susan S.
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Univ Kentucky, Gill Heart Inst, Div Cardiovasc Med, Lexington, KY 40536 USAUniv Kentucky, Gill Heart Inst, Div Cardiovasc Med, Lexington, KY 40536 USA
Smyth, Susan S.
[1
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机构:
[1] Univ Kentucky, Gill Heart Inst, Div Cardiovasc Med, Lexington, KY 40536 USA
[2] Univ Kentucky, Sch Publ Hlth, Lexington, KY 40536 USA
[3] Univ Kentucky, Dept Internal Med, Lexington, KY 40536 USA
Catheter-based thrombolysis (CBT) is emerging as an option for acute pulmonary embolism (PE). Although prior studies have demonstrated improvement in right ventricular function, little data is available regarding clinical patient outcomes. Our institution adopted CBT as an option for patients with submassive and massive PE and we evaluated its effect on patient outcomes. Two hundred and twenty-one patients who presented to our institution with submassive and massive PE were analyzed over three years by time period; 102 prior to the use of CBT and 119 during the time CBT was performed. The primary outcome was in-hospital major adverse clinical events (a composite of death, recurrent embolism, major bleeding, or stroke). Secondary outcomes were overall and ICU length of stay and individual components of the composite outcome. Mean age was 56.3 +/- 16 years with high rates of central PE (57.9%), RV dysfunction (37%), and myocardial necrosis (26%). Mean RV/LV ratio was 1.2. Thirty-two patients were treated with CBT. The composite endpoint occurred more frequently in the CBT era vs the pre-CBT era (21.0% vs 14.7%, p=0.23). After multivariate adjustment, CBT treatment demonstrated no effect on major adverse clinical events (OR 0.84, CI 0.22-3.22, p=0.80). CBT era patients had an unadjusted 37% increase in ICU days and 54% increase in total length of stay (p<0.001). Within the CBT era, CBT treatment resulted in an adjusted 190% increase in overall length of stay (p<0.001). CBT did not demonstrate improvement in hospital outcomes, despite adjustments of PE severity, and was associated with a significant increase in overall and ICU length of stay.
机构:Michigan State Univ, Program Emergency Med, Spectrum Hlth Butterworth, Grand Rapids MERC, Grand Rapids, MI USA
Worster, Andrew
Smith, Camala
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机构:Michigan State Univ, Program Emergency Med, Spectrum Hlth Butterworth, Grand Rapids MERC, Grand Rapids, MI USA
Smith, Camala
Silver, Shawna
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机构:Michigan State Univ, Program Emergency Med, Spectrum Hlth Butterworth, Grand Rapids MERC, Grand Rapids, MI USA
Silver, Shawna
Brown, Michael D.
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Michigan State Univ, Program Emergency Med, Spectrum Hlth Butterworth, Grand Rapids MERC, Grand Rapids, MI USAMichigan State Univ, Program Emergency Med, Spectrum Hlth Butterworth, Grand Rapids MERC, Grand Rapids, MI USA
机构:
Brigham & Womens Hosp, Vasc Med Sect, Div Cardiovasc, Boston, MA 02115 USABrigham & Womens Hosp, Vasc Med Sect, Div Cardiovasc, Boston, MA 02115 USA
Todoran, Thomas M.
Sobieszczyk, Piotr
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Brigham & Womens Hosp, Vasc Med Sect, Div Cardiovasc, Boston, MA 02115 USABrigham & Womens Hosp, Vasc Med Sect, Div Cardiovasc, Boston, MA 02115 USA
机构:
Univ Hlth Sci, Dept Cardiol, Istanbul Mehmet Akif Ersoy Thorac & Cardiovasc Su, Istanbul, TurkiyeUniv Hlth Sci, Dept Cardiol, Istanbul Mehmet Akif Ersoy Thorac & Cardiovasc Su, Istanbul, Turkiye
Guner, Ahmet
Uzun, Fatih
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Univ Hlth Sci, Dept Cardiol, Istanbul Mehmet Akif Ersoy Thorac & Cardiovasc Su, Istanbul, TurkiyeUniv Hlth Sci, Dept Cardiol, Istanbul Mehmet Akif Ersoy Thorac & Cardiovasc Su, Istanbul, Turkiye
Uzun, Fatih
Guner, Ezgi Gultekin
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Univ Hlth Sci, Dept Cardiol, Istanbul Mehmet Akif Ersoy Thorac & Cardiovasc Su, Istanbul, TurkiyeUniv Hlth Sci, Dept Cardiol, Istanbul Mehmet Akif Ersoy Thorac & Cardiovasc Su, Istanbul, Turkiye
Guner, Ezgi Gultekin
Akman, Cemalettin
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Univ Hlth Sci, Dept Cardiol, Istanbul Mehmet Akif Ersoy Thorac & Cardiovasc Su, Istanbul, TurkiyeUniv Hlth Sci, Dept Cardiol, Istanbul Mehmet Akif Ersoy Thorac & Cardiovasc Su, Istanbul, Turkiye
Akman, Cemalettin
Erturk, Mehmet
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Univ Hlth Sci, Dept Cardiol, Istanbul Mehmet Akif Ersoy Thorac & Cardiovasc Su, Istanbul, TurkiyeUniv Hlth Sci, Dept Cardiol, Istanbul Mehmet Akif Ersoy Thorac & Cardiovasc Su, Istanbul, Turkiye