Timothy Lee1, Shinobu Itagaki1, Yuting P Chiang2, Natalia N Egorova3, David H Adams1, Joanna Chikwe4. 1. Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY. 2. Department of Surgery, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY. 3. Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY. 4. Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY; Division of Cardiothoracic Surgery, Department of Surgery, Stony Brook University Hospital, Stony Brook, NY. Electronic address: Joanna.Chikwe@mountsinai.org.
Abstract
BACKGROUND: Pulmonary embolism (PE) results in more than 250,000 hospitalizations annually in the United States, with high mortality. Outcome data are limited, and reperfusion strategies remain controversial. Here we evaluated the outcomes of thrombolysis and surgical embolectomy in patients with acute PE using a statewide database. METHODS: Among 174,322 patients hospitalized with PE in New York State between 1999 and 2013, we performed a retrospective comparison of 2111 adults with acute PE who underwent either thrombolysis (n = 1854; 88%) or surgical embolectomy (n = 257; 12%) as first-line therapy. Patients were identified using a mandatory database. The median follow-up was 4.2 years (range, 0-16.3 years). The primary study endpoint was all-cause mortality; secondary outcomes included recurrent PE, recurrent deep vein thrombosis, reintervention, and stroke. RESULTS: In 2111 patients who underwent reperfusion, there was no difference in 30-day mortality between those who underwent thrombolysis and those who underwent surgical embolectomy (15.2% vs 13.2%; odds ratio [OR], 1.12, 95% confidence interval [CI], 0.72-1.73). Thrombolysis was associated with higher risk of stroke (1.9% vs 0.8%; OR, 4.70; 95% CI, 1.08-20.42) and reintervention (3.8% vs 1.2%; OR, 7.16; 95% CI, 2.17-23.62) at 30 days. Five-year actuarial survival was similar in the 2 groups (72.4% [95% CI, 70.3%-74.5%] vs 76.1% [95% CI, 70.2%-81.0%]; hazard ratio (HR) for death, 1.11; 95% CI, 0.83-1.49). Thrombolysis was associated with a higher rate of recurrent PE necessitating inpatient readmission (7.9% [95% CI, 6.9%-9.4%] vs 2.8% [95% CI, 1.1%-5.8%]; HR, 3.38; 95% CI, 1.48-7.73). CONCLUSIONS: Pulmonary embolectomy and thrombolysis are associated with similar early and long-term survival, supporting guideline recommendations for embolectomy when thrombolysis is contraindicated.
BACKGROUND:Pulmonary embolism (PE) results in more than 250,000 hospitalizations annually in the United States, with high mortality. Outcome data are limited, and reperfusion strategies remain controversial. Here we evaluated the outcomes of thrombolysis and surgical embolectomy in patients with acute PE using a statewide database. METHODS: Among 174,322 patients hospitalized with PE in New York State between 1999 and 2013, we performed a retrospective comparison of 2111 adults with acute PE who underwent either thrombolysis (n = 1854; 88%) or surgical embolectomy (n = 257; 12%) as first-line therapy. Patients were identified using a mandatory database. The median follow-up was 4.2 years (range, 0-16.3 years). The primary study endpoint was all-cause mortality; secondary outcomes included recurrent PE, recurrent deep vein thrombosis, reintervention, and stroke. RESULTS: In 2111 patients who underwent reperfusion, there was no difference in 30-day mortality between those who underwent thrombolysis and those who underwent surgical embolectomy (15.2% vs 13.2%; odds ratio [OR], 1.12, 95% confidence interval [CI], 0.72-1.73). Thrombolysis was associated with higher risk of stroke (1.9% vs 0.8%; OR, 4.70; 95% CI, 1.08-20.42) and reintervention (3.8% vs 1.2%; OR, 7.16; 95% CI, 2.17-23.62) at 30 days. Five-year actuarial survival was similar in the 2 groups (72.4% [95% CI, 70.3%-74.5%] vs 76.1% [95% CI, 70.2%-81.0%]; hazard ratio (HR) for death, 1.11; 95% CI, 0.83-1.49). Thrombolysis was associated with a higher rate of recurrent PE necessitating inpatient readmission (7.9% [95% CI, 6.9%-9.4%] vs 2.8% [95% CI, 1.1%-5.8%]; HR, 3.38; 95% CI, 1.48-7.73). CONCLUSIONS: Pulmonary embolectomy and thrombolysis are associated with similar early and long-term survival, supporting guideline recommendations for embolectomy when thrombolysis is contraindicated.
Authors: Catherine Ross; Riten Kumar; Marie-Claude Pelland-Marcotte; Shivani Mehta; Monica E Kleinman; Ravi R Thiagarajan; Muhammad B Ghbeis; Christina J VanderPluym; Kevin G Friedman; Diego Porras; Francis Fynn-Thompson; Samuel Z Goldhaber; Leonardo R Brandão Journal: Chest Date: 2021-09-26 Impact factor: 9.410