title: Utilization of catheter-directed thrombolysis in pulmonary embolism and outcome difference between systemic thrombolysis and catheter-directed thrombolysis.
abstract: OBJECTIVE
  The aim of the study was to assess the utilization of catheter-directed thrombolysis (CDT) and its comparative effectiveness against systemic thrombolysis in acute pulmonary embolism (PE).
  
  
  BACKGROUND
  Contemporary real world data regarding utilization and outcomes comparing systemic thrombolysis with CDT for PE is sparse.
  
  
  METHODS
  We queried the Nationwide Inpatient Sample from 2010 to 2012 using the ICD-9-CM diagnosis code 415.11, 415.13, and 415.19 for acute PE. We used propensity score analysis to compare outcomes between systemic thrombolysis and CDT. Primary outcome was in-hospital mortality. Secondary outcome was combined in-hospital mortality and intracranial hemorrhage (ICH).
  
  
  RESULTS
  Out of 110,731 patients hospitalized with PE, we identified 1,521 patients treated with thrombolysis, of which 1,169 patients received systemic thrombolysis and 352 patients received CDT. After propensity-matched comparison, primary and secondary outcomes were significantly lower in the CDT group compared to systemic thrombolysis (21.81% vs. 13.36%, OR 0.55, 95% CI 0.36-0.85, P value = 0.007) and (22.89% vs. 13.36%, OR 0.52, 95% CI 0.34-0.80, P value = 0.003), respectively. The median length of stay [7 days, interquartile range (IQR) (5-9 days) vs. 7 days, IQR (5-10 days), P = 0.17] was not significant between the two groups. The CDT group had higher cost of hospitalization [$17,218, IQR ($12,272-$23,906) vs. $23,799, IQR ($17,892-$35,338), P < 0.001]. Multivariate analysis identified increasing age, saddle PE, cardiopulmonary arrest, and Medicaid insurance as independent predictors of in-hospital mortality.
  
  
  CONCLUSIONS
  CDT was associated with lower in-hospital mortality and combined in-hospital mortality and ICH.
authors: Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida.
authors: Nish
authors: N
authors: Patel
authors: Internal Medicine Department, Staten Island University Hospital, Staten Island, New York.
authors: Nileshkumar J
authors: NJ
authors: Patel
authors: Internal Medicine Department, Saint Peters University Hospital, New Brunswick, New Jersey.
authors: Kanishk
authors: K
authors: Agnihotri
authors: Cardiology Department, Detroit Medical Center, Detroit, Michigan.
authors: Sidakpal S
authors: SS
authors: Panaich
authors: Internal Medicine Department, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana.
authors: Badal
authors: B
authors: Thakkar
authors: Internal Medicine Department, Icahn School of Medicine at Mount Sinai, New York, New York.
authors: Achint
authors: A
authors: Patel
authors: Internal Medicine Department, New York Medical College, Valhalla, New York.
authors: Chirag
authors: C
authors: Savani
authors: Internal Medicine Department, Saint Peters University Hospital, New Brunswick, New Jersey.
authors: Nilay
authors: N
authors: Patel
authors: Internal Medicine Department, Mount Sinai St Luke's Roosevelt Hospital, New York, New York.
authors: Shilpkumar
authors: S
authors: Arora
authors: Cardiology Department, Mayo Clinic, Rochester, Minnesota.
authors: Abhishek
authors: A
authors: Deshmukh
authors: Internal Medicine Department, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana.
authors: Parth
authors: P
authors: Bhatt
authors: Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida.
authors: Carlos
authors: C
authors: Alfonso
authors: Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida.
authors: Mauricio
authors: M
authors: Cohen
authors: Cardiology Department, North Shore University Health System, Chicago, Illinois.
authors: Alfonso
authors: A
authors: Tafur
authors: Cardiology Department, Detroit Medical Center, Detroit, Michigan.
authors: Mahir
authors: M
authors: Elder
authors: Cardiology Department, Detroit Medical Center, Detroit, Michigan.
authors: Tamam
authors: T
authors: Mohamed
authors: Cardiology Department, Yale School of Medicine, New Haven, Connecticut.
authors: Ramak
authors: R
authors: Attaran
authors: Cardiology Department, Detroit Medical Center, Detroit, Michigan.
authors: Theodore
authors: T
authors: Schreiber
authors: Cardiology Department, Detroit Medical Center, Detroit, Michigan.
authors: Cindy
authors: C
authors: Grines
authors: Cardiology Department, Yale School of Medicine, New Haven, Connecticut.
authors: Apurva O
authors: AO
authors: Badheka
mesh_terms: D000328:Adult; D000368:Aged; D002407:Catheterization, Swan-Ganz / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data / Q000639:trends; D016009:Chi-Square Distribution; D016208:Databases, Factual; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D017052:Hospital Mortality; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced; D016015:Logistic Models; D008297:Male; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000639:trends; D057216:Propensity Score; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D005343:Fibrinolytic Agents
keywords: CDT; fibrinolysis; hospitalization; outcomes research; peripheral interventions; pulmonary embolism; thrombolysis; trends; venous thromboembolism