PDF(Pubmed)
Abstract：
The purpose of this study is to evaluate whether early initiation of catheter-directed thrombolysis (CDT) in patients presenting with acute pulmonary embolism is associated with improved in-hospital outcomes. A retrospective cohort was extracted from the 2016-2019 National Inpatient Sample database, consisting of 21,730 weighted admissions undergoing CDT acute PE. From the time of admission, the sample was divided into early (<48 h) and late interventions (>48 h). Outcomes were measured using regression analysis and propensity score matching. No significant differences in mortality, cardiac arrest, cardiogenic shock, or intracranial hemorrhage (p > 0.05) were found between the early and late CDT groups. Late CDT patients had a higher likelihood of receiving systemic thrombolysis (3.21 [2.18-4.74], p < 0.01), blood transfusion (1.84 [1.41-2.40], p < 0.01), intubation (1.33 [1.05-1.70], p = 0.02), discharge disposition to care facilities (1.32 [1.14-1.53], p < 0.01). and having acute kidney injury (1.42 [1.25-1.61], p < 0.01). Predictors of late intervention were older age, female sex, non-white ethnicity, non-teaching hospital admission, hospitals with higher bed sizes, and weekend admission (p < 0.01). This study represents a comprehensive evaluation of outcomes associated with the time interval for initiating CDT, revealing reduced morbidity with early intervention. Additionally, it identifies predictors associated with delayed CDT initiation. The broader ramifications of these findings, particularly in relation to hospital resource utilization and health disparities, warrant further exploration.
摘要：
这项研究的目的是评估急性肺栓塞患者早期开始导管溶栓（CDT）是否与改善院内预后相关。从2016-2019年全国住院患者样本数据库中提取了一个回顾性队列，包括21,730名接受CDT急性PE的加权入院。从入院时开始，样本分为早期干预(<48h)和晚期干预(>48h)。使用回归分析和倾向评分匹配来衡量结果。死亡率没有显着差异，心脏骤停,心源性休克,早期和晚期CDT组之间发现颅内出血（p>0.05）。晚期CDT患者接受全身溶栓的可能性更高(3.21[2.18-4.74],p<0.01),输血（1.84[1.41-2.40]，p<0.01),插管(1.33[1.05-1.70],p=0.02),护理设施的出院处置(1.32[1.14-1.53]，p<0.01)。并患有急性肾损伤（1.42[1.25-1.61]，p<0.01)。晚期干预的预测因素是年龄较大，女性性别,非白人种族,非教学入院，病床尺寸更大的医院，和周末入院（p<0.01）。这项研究代表了与启动CDT的时间间隔相关的结果的综合评估，揭示早期干预降低发病率。此外,它确定了与延迟CDT启动相关的预测因子。这些发现的更广泛的影响，特别是在医院资源利用和健康差距方面，值得进一步探索。
