Navkaranbir S Bajaj1, Rajat Kalra2, Pankaj Arora3, Sameer Ather3, Jason L Guichard3, W Jake Lancaster4, Nirav Patel3, Fabio Raman5, Garima Arora3, Firas Al Solaiman3, D Trey Clark6, Louis J Dell'Italia7, Massoud A Leesar3, James E Davies8, David C McGiffin9, Mustafa I Ahmed10. 1. 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. 2. Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA; Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA. 3. Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA. 4. Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. 5. University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA. 6. Department of Cardiology, Cleveland Clinic, Cleveland, OH, USA. 7. Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama, USA; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, United States. 8. Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA. 9. Division of Cardiothoracic Surgery, Department of Surgery, Alfred Hospital and Monash University, Melbourne, Australia. 10. 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.
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.
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.
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