Arkadiusz Pietrasik, Paweł Kurzyna, Piotr Szwed, Karolina Jasińska-Gniadzik, Aleksandra Gąsecka, Szymona Darocha, Dariusz Zieliński, Łukasz Szarpak, Janusz Kochman, Marcin Grabowski, Grzegorz Opolski, Adam Torbicki, Marcin Kurzyna
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引用次数: 0
Abstract
Background: Multidisciplinary Pulmonary Embolism Response Teams (PERTs) were established to individualize the treatment of high-risk (HR) and intermediate-high-risk (IHR) pulmonary embolism (PE) patients, which pose a challenge in clinical practice.
Methods: We retrospectively collected the data of all HR and IHR acute PE patients consulted by PERT CELZAT between September 2017 and October 2022. The patient population was divided into four different treatment methods: anticoagulation alone (AC), systemic thrombolysis (ST), surgical embolectomy (SE), and catheter-directed therapies (CDTx). Baseline clinical characteristics, risk stratification, PE severity parameters, and treatment outcomes were compared between the four groups.
Results: Of the 110 patients with HR and IHR PE, 67 (61%) patients were treated with AC only, 11 (10%) with ST, 15 (14%) underwent SE, and 17 (15%) were treated with CTDx. The most common treatment option in the HR group was reperfusion therapy, used in 20/24 (83%) cases, including ST in 7 (29%) patients, SE in 5 (21%) patients, and CTDx in 8 (33%) patients. In contrast, IHR patients were treated with AC alone in 63/86 (73%) cases. The in-hospital mortality rate was 9/24 (37.5%) in the HR group and 4/86 (4.7%) in the IHR group.
Conclusions: The number of advanced procedures aimed at reperfusion was substantially higher in the HR group than in the IHR PE group. Despite the common use of advanced reperfusion techniques in the HR group, patient mortality remained high. There is a need further to optimize the treatment of patients with HR PE to improve outcomes.
背景：多学科肺栓塞反应小组（PERT）的成立是为了对高危（HR）和中高危（IHR）肺栓塞（PE）患者进行个体化治疗，这在临床实践中是一项挑战：我们回顾性地收集了2017年9月至2022年10月期间PERT CELZAT就诊的所有HR和IHR急性PE患者的数据。患者人群被分为四种不同的治疗方法：单纯抗凝（AC）、全身溶栓（ST）、外科栓子切除术（SE）和导管导向疗法（CDTx）。对四组患者的基线临床特征、风险分层、PE严重程度参数和治疗结果进行了比较：在110例HR和IHR PE患者中，67例（61%）仅接受AC治疗，11例（10%）接受ST治疗，15例（14%）接受SE治疗，17例（15%）接受CTDx治疗。在 HR 组中，最常见的治疗方案是再灌注治疗，有 20/24 例（83%）患者采用了再灌注治疗，其中 7 例（29%）患者采用了 ST 治疗，5 例（21%）患者采用了 SE 治疗，8 例（33%）患者采用了 CTDx 治疗。相比之下，63/86（73%）例 IHR 患者仅接受了 AC 治疗。HR组的院内死亡率为9/24（37.5%），IHR组为4/86（4.7%）：结论：HR 组以再灌注为目的的高级手术数量大大高于 IHR PE 组。尽管HR组常用先进的再灌注技术，但患者死亡率仍然很高。有必要进一步优化对HR PE患者的治疗，以改善预后。
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