Edward D Percy1, Rohan Shah2, Sameer Hirji2, Richard J Tartarini3, Farhang Yazdchi2, Morgan Harloff2, Tsuyoshi Kaneko2, Marc P Pelletier4. 1. Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Division of Cardiovascular Surgery, University of British Columbia, Vancouver, British Columbia, Canada. 2. Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts. 3. Albany Medical College, Albany, New York. 4. Division of Cardiac Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio. Electronic address: marc.pelletier@uhhospitals.org.
Abstract
BACKGROUND: Guidelines outlining the role of surgical embolectomy for acute pulmonary embolism remain consensus based; however, recent outcomes have improved compared with traditional experiences. This study examined contemporary outcomes of patients treated for acute pulmonary embolism on a nationwide scale. METHODS: Patients undergoing systemic thrombolysis, catheter-directed therapy, and surgical embolectomy for acute pulmonary embolism from 2010 to 2014 in the National Inpatient Sample were included. RESULTS: The study included 58,974 patients with acute pulmonary embolism; of these, 33,553 were treated with systemic thrombolysis, 22,336 with catheter-directed therapy, and 3085 underwent surgical embolectomy. Thrombolysis was the most common, with a substantial increase after 2012, while surgical volumes remained stable. Patients in the surgical group, compared with systemic thrombolysis and catheter-directed therapy, had more saddle emboli (22% vs 10% vs 10%) and were more frequently at severe risk of death (56% vs 42% vs 26%; both P < .01). Surgical embolectomy patients had higher in-hospital mortality (20% vs 16% vs 7%), stroke (7% vs 6% vs 3%), and blood transfusion (32% vs 16% vs 10%; all P < .01). Rates of major bleeding and intracranial hemorrhage were highest in the systemic thrombolysis group. Among surgical patients, age older than 60 years, atrial fibrillation and nonsaddle embolus were associated with increased odds of mortality. CONCLUSIONS: In this contemporary, real-world study, mortality occurred in 19.8% of patients undergoing surgical embolectomy for acute pulmonary embolism. This represents a significant improvement compared with traditional outcomes and supports the role of surgery in the multidisciplinary treatment of this high-risk condition.
BACKGROUND: Guidelines outlining the role of surgical embolectomy for acute pulmonary embolism remain consensus based; however, recent outcomes have improved compared with traditional experiences. This study examined contemporary outcomes of patients treated for acute pulmonary embolism on a nationwide scale. METHODS:Patients undergoing systemic thrombolysis, catheter-directed therapy, and surgical embolectomy for acute pulmonary embolism from 2010 to 2014 in the National Inpatient Sample were included. RESULTS: The study included 58,974 patients with acute pulmonary embolism; of these, 33,553 were treated with systemic thrombolysis, 22,336 with catheter-directed therapy, and 3085 underwent surgical embolectomy. Thrombolysis was the most common, with a substantial increase after 2012, while surgical volumes remained stable. Patients in the surgical group, compared with systemic thrombolysis and catheter-directed therapy, had more saddle emboli (22% vs 10% vs 10%) and were more frequently at severe risk of death (56% vs 42% vs 26%; both P < .01). Surgical embolectomy patients had higher in-hospital mortality (20% vs 16% vs 7%), stroke (7% vs 6% vs 3%), and blood transfusion (32% vs 16% vs 10%; all P < .01). Rates of major bleeding and intracranial hemorrhage were highest in the systemic thrombolysis group. Among surgical patients, age older than 60 years, atrial fibrillation and nonsaddle embolus were associated with increased odds of mortality. CONCLUSIONS: In this contemporary, real-world study, mortality occurred in 19.8% of patients undergoing surgical embolectomy for acute pulmonary embolism. This represents a significant improvement compared with traditional outcomes and supports the role of surgery in the multidisciplinary treatment of this high-risk condition.
Authors: Arkadiusz Pietrasik; Aleksandra Gąsecka; Łukasz Szarpak; Michał Pruc; Tomasz Kopiec; Szymon Darocha; Marta Banaszkiewicz; Maciej Niewada; Marcin Grabowski; Marcin Kurzyna Journal: Front Cardiovasc Med Date: 2022-06-16