Contemporary Management and Outcomes of Patients With High-Risk Pulmonary Embolism
Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved..
BACKGROUND: Contemporary care patterns/outcomes in high-risk pulmonary embolism (PE) patients are unknown.
OBJECTIVES: This study sought to characterize the management of high-risk PE patients and identify factors associated with poor outcomes.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: In the largest analysis of high-risk PE patients to date, mortality rates were high with the worst outcomes among patients with hemodynamic collapse.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:83 |
|---|---|
| Enthalten in: |
Journal of the American College of Cardiology - 83(2024), 1 vom: 02. Jan., Seite 35-43 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Kobayashi, Taisei [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Catheter-directed embolectomy |
|---|
| Anmerkungen: |
Date Completed 05.01.2024 Date Revised 05.01.2024 published: Print Citation Status MEDLINE |
|---|
| doi: |
10.1016/j.jacc.2023.10.026 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM366623281 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM366623281 | ||
| 003 | DE-627 | ||
| 005 | 20240108142310.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 240108s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.jacc.2023.10.026 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1249.xml |
| 035 | |a (DE-627)NLM366623281 | ||
| 035 | |a (NLM)38171708 | ||
| 035 | |a (PII)S0735-1097(23)07981-0 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Kobayashi, Taisei |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Contemporary Management and Outcomes of Patients With High-Risk Pulmonary Embolism |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 05.01.2024 | ||
| 500 | |a Date Revised 05.01.2024 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Contemporary care patterns/outcomes in high-risk pulmonary embolism (PE) patients are unknown | ||
| 520 | |a OBJECTIVES: This study sought to characterize the management of high-risk PE patients and identify factors associated with poor outcomes | ||
| 520 | |a METHODS: 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 | ||
| 520 | |a RESULTS: 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 | ||
| 520 | |a CONCLUSIONS: In the largest analysis of high-risk PE patients to date, mortality rates were high with the worst outcomes among patients with hemodynamic collapse | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a ECMO | |
| 650 | 4 | |a catheter-directed embolectomy | |
| 650 | 4 | |a catheter-directed thrombolysis | |
| 650 | 4 | |a high-risk pulmonary embolism | |
| 650 | 4 | |a pulmonary embolism | |
| 650 | 4 | |a systemic thrombolysis | |
| 700 | 1 | |a Pugliese, Steven |e verfasserin |4 aut | |
| 700 | 1 | |a Sethi, Sanjum S |e verfasserin |4 aut | |
| 700 | 1 | |a Parikh, Sahil A |e verfasserin |4 aut | |
| 700 | 1 | |a Goldberg, Joshua |e verfasserin |4 aut | |
| 700 | 1 | |a Alkhafan, Fahad |e verfasserin |4 aut | |
| 700 | 1 | |a Vitarello, Clara |e verfasserin |4 aut | |
| 700 | 1 | |a Rosenfield, Kenneth |e verfasserin |4 aut | |
| 700 | 1 | |a Lookstein, Robert |e verfasserin |4 aut | |
| 700 | 1 | |a Keeling, Brent |e verfasserin |4 aut | |
| 700 | 1 | |a Klein, Andrew |e verfasserin |4 aut | |
| 700 | 1 | |a Gibson, C Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Glassmoyer, Lauren |e verfasserin |4 aut | |
| 700 | 1 | |a Khandhar, Sameer |e verfasserin |4 aut | |
| 700 | 1 | |a Secemsky, Eric |e verfasserin |4 aut | |
| 700 | 1 | |a Giri, Jay |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Journal of the American College of Cardiology |d 1987 |g 83(2024), 1 vom: 02. Jan., Seite 35-43 |w (DE-627)NLM012608602 |x 1558-3597 |7 nnns |
| 773 | 1 | 8 | |g volume:83 |g year:2024 |g number:1 |g day:02 |g month:01 |g pages:35-43 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.jacc.2023.10.026 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 83 |j 2024 |e 1 |b 02 |c 01 |h 35-43 | ||