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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Veröffentlicht in:	Journal of the American College of Cardiology Jg. 83; H. 1; S. 35
Hauptverfasser:	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
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	United States 02.01.2024
Schlagworte:	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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Abstract	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.
AbstractList	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. Contemporary care patterns/outcomes in high-risk pulmonary embolism (PE) patients are unknown.BACKGROUNDContemporary 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.OBJECTIVESThis 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.METHODSA 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.RESULTSOf 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.CONCLUSIONSIn the largest analysis of high-risk PE patients to date, mortality rates were high with the worst outcomes among patients with hemodynamic collapse.
Author	Pugliese, Steven Sethi, Sanjum S Keeling, Brent Alkhafan, Fahad Vitarello, Clara Secemsky, Eric Giri, Jay Goldberg, Joshua Khandhar, Sameer Lookstein, Robert Klein, Andrew Gibson, C Michael Glassmoyer, Lauren Rosenfield, Kenneth Parikh, Sahil A Kobayashi, Taisei
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Keywords	ECMO high-risk pulmonary embolism systemic thrombolysis catheter-directed embolectomy catheter-directed thrombolysis pulmonary embolism
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Snippet	Contemporary care patterns/outcomes in high-risk pulmonary embolism (PE) patients are unknown. This study sought to characterize the management of high-risk PE... Contemporary care patterns/outcomes in high-risk pulmonary embolism (PE) patients are unknown.BACKGROUNDContemporary care patterns/outcomes in high-risk...
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SubjectTerms	Hemorrhage - etiology Humans Logistic Models Pulmonary Embolism - therapy Retrospective Studies Risk Factors Thrombolytic Therapy - adverse effects Treatment Outcome
Title	Contemporary Management and Outcomes of Patients With High-Risk Pulmonary Embolism
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