Impact of the Balloon Pulmonary Angioplasty on the Diagnosis of Chronic Thromboembolic Pulmonary Hypertension: From the COMMAND VTE Registry-2

Abstract

Background

Chronic thromboembolic pulmonary hypertension (CTEPH) is the most serious long-term complication of acute pulmonary embolism (PE). Balloon pulmonary angioplasty (BPA) has been an effective treatment for improving the prognosis of CTEPH patients.

Aims

This study aimed to evaluate the impact of BPA at each institution on the rate of CTEPH diagnosis based on the observations suggesting that the emergence of effective treatments could draw attention to targeted diseases.

Methods

The COMMAND VTE Registry-2 is a multicenter, retrospective cohort study of 5197 patients diagnosed with venous thromboembolism (VTE) at 31 medical centers in Japan. The study included 2787 patients with acute PE, who were divided into the BPA-capable facility group (BPA centers) and the non-BPA-capable facility group (non-BPA centers). We investigated the difference in the rate of CTEPH diagnosis after acute PE between the two groups.

Results

Among patients with acute PE, 723 patients (25.9%) and 2064 patients (74.1%) were diagnosed at BPA centers and non-BPA centers, respectively. There were 48 patients who were diagnosed with CTEPH, with a median follow-up period of 747 days. The cumulative 3-year incidence of CTEPH diagnosis was 5.0% in the BPA centers and 1.4% in the non-BPA centers (crude hazard ratio [HR]: 3.80; 95% CI: 2.15–6.72; p < 0.001).

Conclusion

The cumulative 3-year incidence of CTEPH diagnosis after acute PE was significantly greater in BPA centers than in non-BPA centers, which suggests the importance of appropriate awareness of CTEPH and BPA.