Ryan Nolan, Maanasi Samant, Suresh Vedantham, Westley Ohman, Nathan Droz, Kristen Sanfilippo, Pavan Kavali
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引用次数: 0
Abstract
Purpose: To determine if use of mechanical thrombectomy (MT) impacts survival and additional outcomes in patients with acute intermediate-high-risk and high-risk pulmonary embolism (PE) who were evaluated by a Pulmonary Embolism Response Team (PERT).
Methods: This retrospective, single-center study included patients with intermediate-high-risk and high-risk PE who received PERT evaluation over 3.5 years and were treated with anticoagulation (AC) alone or MT + AC. The primary outcome was 30-day all-cause mortality, measured with inverse probability of treatment weighting. Exploratory outcomes included survival during the study period, PE-associated/caused mortality, hospital length of stay (LOS), supplemental oxygen at discharge, and MT-related metrics.
Results: Of 335 patients, 259 received AC alone and 76 received MT + AC. The use of MT was associated with reduced odds of 30-day all-cause mortality (odds ratio, 0.49; 95% CI, 0.27-0.76; P = .002). There were no significant differences in PE-associated/caused mortality. Hospital LOS was 2 days shorter in the MT + AC cohort (P < .001). Of patients receiving MT + AC, those with high-risk PE had a 4.5-day shorter stay (P < .001), whereas those with intermediate-high-risk PE had a 2-day shorter stay (P < .001). The proportion of patients receiving supplemental oxygen at discharge was lower in the MT + AC group (MT + AC vs AC, 4.1% vs 18.5%; P < .001), without significant differences in 30-day readmission rates (MT + AC vs AC, 9.5% vs 20.6%; P = .115). MT resulted in an 8.7-mm Hg reduction in mean pulmonary artery pressure, had a technical success rate of 100% (76 of 76), and an adverse event rate of 6.6% (5 of 76).
Conclusions: MT reduced 30-day all-cause mortality, hospital LOS, and supplemental oxygen at discharge in the intermediate-high-risk and high-risk PE population.
期刊介绍:
JVIR, published continuously since 1990, is an international, monthly peer-reviewed interventional radiology journal. As the official journal of the Society of Interventional Radiology, JVIR is the peer-reviewed journal of choice for interventional radiologists, radiologists, cardiologists, vascular surgeons, neurosurgeons, and other clinicians who seek current and reliable information on every aspect of vascular and interventional radiology. Each issue of JVIR covers critical and cutting-edge medical minimally invasive, clinical, basic research, radiological, pathological, and socioeconomic issues of importance to the field.