title: A retrospective analysis of catheter-based thrombolytic therapy for acute submassive and massive pulmonary embolism.
abstract: 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.
authors.affiliation: Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, USA.
authors.forename: Bennet
authors.initials: B
authors.lastname: George
authors.affiliation: Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, USA.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Wallace
authors.affiliation: School of Public Health, University of Kentucky, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Charnigo
authors.affiliation: Department of Internal Medicine, University of Kentucky, USA.
authors.forename: Kelly E
authors.initials: KE
authors.lastname: Wingerter
authors.affiliation: Department of Internal Medicine, University of Kentucky, USA.
authors.forename: Pavan
authors.initials: P
authors.lastname: Kapadia
authors.affiliation: Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Gurley
authors.affiliation: Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, USA ssmyt2@email.uky.edu.
authors.forename: Susan S
authors.initials: SS
authors.lastname: Smyth
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D057785:Catheters; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000628:therapy*; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: catheter-based thrombolysis; fibrinolytics; outcomes; pulmonary embolism; submassive