Nish Patel1, Nileshkumar J Patel2, Kanishk Agnihotri3, Sidakpal S Panaich4, Badal Thakkar5, Achint Patel6, Chirag Savani7, Nilay Patel3, Shilpkumar Arora8, Abhishek Deshmukh9, Parth Bhatt5, Carlos Alfonso1, Mauricio Cohen1, Alfonso Tafur10, Mahir Elder4, Tamam Mohamed4, Ramak Attaran11, Theodore Schreiber4, Cindy Grines4, Apurva O Badheka11. 1. Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida. 2. Internal Medicine Department, Staten Island University Hospital, Staten Island, New York. 3. Internal Medicine Department, Saint Peters University Hospital, New Brunswick, New Jersey. 4. Cardiology Department, Detroit Medical Center, Detroit, Michigan. 5. Internal Medicine Department, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana. 6. Internal Medicine Department, Icahn School of Medicine at Mount Sinai, New York, New York. 7. Internal Medicine Department, New York Medical College, Valhalla, New York. 8. Internal Medicine Department, Mount Sinai St Luke's Roosevelt Hospital, New York, New York. 9. Cardiology Department, Mayo Clinic, Rochester, Minnesota. 10. Cardiology Department, North Shore University Health System, Chicago, Illinois. 11. Cardiology Department, Yale School of Medicine, New Haven, Connecticut.
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.
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.
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