Contemporary Management and Outcomes of Patients With High-Risk Pulmonary Embolism

Contemporary care patterns/outcomes in high-risk pulmonary embolism (PE) patients are unknown. This study sought to characterize the management of high-risk PE patients and identify factors associated with poor outcomes. A retrospective analysis of the PERT (Pulmonary Embolism Response Team) Consort...

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Vydané v:Journal of the American College of Cardiology Ročník 83; číslo 1; s. 35
Hlavní autori: Kobayashi, Taisei, Pugliese, Steven, Sethi, Sanjum S, Parikh, Sahil A, Goldberg, Joshua, Alkhafan, Fahad, Vitarello, Clara, Rosenfield, Kenneth, Lookstein, Robert, Keeling, Brent, Klein, Andrew, Gibson, C Michael, Glassmoyer, Lauren, Khandhar, Sameer, Secemsky, Eric, Giri, Jay
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: United States 02.01.2024
Predmet:
Hemorrhage - etiology
Humans
Logistic Models
Pulmonary Embolism - therapy
Retrospective Studies
Risk Factors
Thrombolytic Therapy - adverse effects
Treatment Outcome
ECMO
high-risk pulmonary embolism
systemic thrombolysis
catheter-directed embolectomy
catheter-directed thrombolysis
pulmonary embolism
ISSN:1558-3597, 1558-3597
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Shrnutí:Contemporary care patterns/outcomes in high-risk pulmonary embolism (PE) patients are unknown. This study sought to characterize the management of high-risk PE patients and identify factors associated with poor outcomes. A retrospective analysis of the PERT (Pulmonary Embolism Response Team) Consortium Registry was performed. Patients presenting with intermediate-risk PE, high-risk PE, and catastrophic PE (those with hemodynamic collapse) were identified. Patient characteristics were compared with chi-square testing for categorical covariates and Student's t-test for continuous covariates. Multivariable logistic regression was used to assess associations between clinical characteristics and outcomes in the high-risk population. Of 5,790 registry patients, 2,976 presented with intermediate-risk PE and 1,442 with high-risk PE. High-risk PE patients were more frequently treated with advanced therapies than intermediate-risk PE patients (41.9% vs 30.2%; P < 0.001). In-hospital mortality (20.6% vs 3.7%; P < 0.001) and major bleeding (10.5% vs. 3.5%; P < 0.001) were more common in high-risk PE. Multivariable regression analysis demonstrated vasopressor use (OR: 4.56; 95% CI: 3.27-6.38; P < 0.01), extracorporeal membrane oxygenation use (OR: 2.86; 95% CI: 1.12-7.30; P = 0.03), identified clot-in-transit (OR: 2.26; 95% CI: 1.13-4.52; P = 0.02), and malignancy (OR: = 1.70; 95% CI: 1.13-2.56; P = 0.01) as factors associated with in-hospital mortality. Catastrophic PE patients (n = 197 [13.7% of high-risk PE patients]) had higher in-hospital mortality (42.1% vs 17.2%; P < 0.001) than those presenting with noncatastrophic high-risk PE. Extracorporeal membrane oxygenation (13.3% vs. 4.8% P < 0.001) and systemic thrombolysis (25% vs 11.3%; P < 0.001) were used more commonly in catastrophic PE. In the largest analysis of high-risk PE patients to date, mortality rates were high with the worst outcomes among patients with hemodynamic collapse.
Bibliografia:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:1558-3597
1558-3597
DOI:10.1016/j.jacc.2023.10.026