title: Catheter-directed treatment for acute pulmonary embolism: Systematic review and single-arm meta-analyses.
abstract: BACKGROUND
  We sought to estimate the efficacy and safety outcomes of catheter-directed treatment (CDT) for patients with acute pulmonary embolism (PE).
  
  
  METHODS
  We searched SCOPUS for studies reporting outcomes after CDT for acute PE. Studies were categorized in three groups for analyses due to heterogeneity in the classification of acute PE: 1) patients with PE causing right ventricular dysfunction and haemodynamic instability: unstable haemodynamic status, 2) patients with PE causing right ventricular dysfunction where study outcomes were not stratified by haemodynamic status: stable and unstable haemodynamic status, and 3) patients with PE causing right ventricular dysfunction who remained haemodynamically stable: stable haemodynamic status. Efficacy and safety outcomes were estimated and presented as point estimates with 95% confidence intervals.
  
  
  RESULTS
  In 35 studies with 1253 patients, 1277 CDTs were performed. The in-hospital mortality rates for the unstable haemodynamic status, stable and unstable haemodynamic status, and stable haemodynamic status groups were 18.1% (7.3-38.2%), 7.1% (5.0-10.1%), and 2.6% (0.8-7.3%), respectively. The major bleeding rates across the groups were estimated to be 4.5, 8.5 and 3.9 per 100 CDTs, respectively. Minor bleeding occurred in 6.2, 11.9 and 9.1 per 100 CDTs, respectively. After CDT, all groups had improvements in mean pulmonary artery pressure and right ventricular function.
  
  
  CONCLUSIONS
  We provide descriptive measures of efficacy and safety for patients who underwent CDT for acute PE.
authors.affiliation: Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA; Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA; Division of Cardiovascular Medicine and Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Navkaranbir S
authors.initials: NS
authors.lastname: Bajaj
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA; Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Rajat
authors.initials: R
authors.lastname: Kalra
authors.affiliation: Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Arora
authors.affiliation: Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Sameer
authors.initials: S
authors.lastname: Ather
authors.affiliation: Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Jason L
authors.initials: JL
authors.lastname: Guichard
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: W Jake
authors.initials: WJ
authors.lastname: Lancaster
authors.affiliation: Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Nirav
authors.initials: N
authors.lastname: Patel
authors.affiliation: University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA.
authors.forename: Fabio
authors.initials: F
authors.lastname: Raman
authors.affiliation: Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Garima
authors.initials: G
authors.lastname: Arora
authors.affiliation: Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Firas
authors.initials: F
authors.lastname: Al Solaiman
authors.affiliation: Department of Cardiology, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: D Trey
authors.initials: DT
authors.lastname: Clark
authors.affiliation: Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, United States.
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Dell'Italia
authors.affiliation: Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Massoud A
authors.initials: MA
authors.lastname: Leesar
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: James E
authors.initials: JE
authors.lastname: Davies
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Alfred Hospital and Monash University, Melbourne, Australia.
authors.forename: David C
authors.initials: DC
authors.lastname: McGiffin
authors.affiliation: Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA; Division of Cardiology, Baptist Princeton, Birmingham, Alabama, USA. Electronic address: musiahm@gmail.com.
authors.forename: Mustafa I
authors.initials: MI
authors.lastname: Ahmed
mesh_terms: D000208:Acute Disease; D002404:Catheterization / Q000009:adverse effects / Q000379:methods* / Q000639:trends; D002986:Clinical Trials as Topic / Q000379:methods; D006470:Hemorrhage / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy*; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy
keywords: Catheter-directed treatment; Pulmonary embolism; Thrombolysis